A case of
akinetic mutism was reported with reference to a marked improvement by
levodopa,
bromocriptine and
trihexyphenidyl. A 39-year-old male, first seen on February 2, 1981, had an occipitalgia, accompanied by
nausea and
vomiting. For several months before this consultation, the patient had suffered from
asthenopia. Brain CT scan and cerebral angiogram demonstrated internal
hydrocephalus due to aqueduct
stenosis of unknown etiology. After a
ventriculoperitoneal shunt operation on February 20, 1981, he completely recovered. Two years and a half after the shunt insertion he had no difficulty in his daily life. He reentered the hospital on December 21, 1983, because of personality change,
mental deterioration and
bradykinesia. Brain CT scan showed recurrent
hydrocephalus resulting from shunt blockage. Following the shunt revision,
hydrocephalus was resolved. Nevertheless, the patient did not return to his previous state. And he became bed-ridden, incontinent of urine, and unable to take fluids or foods, following which he went into a state of
akinetic mutism. Other neurological findings were as follows: upward gaze
palsy, impaired convergence,
convergence nystagmus,
plastic rigidity of neck and all four limbs, and diffuse
hyperreflexia with right Babinski's sign. Abnormal
involuntary movement was not seen. On March 27, 1984,
levodopa therapy was instituted and on April 2,
trihexyphenidyl was combined with
levodopa. Shortly after administration of
levodopa and
trihexyphenidyl,
akinetic mutism began to improve, but upward gaze
palsy was not affected. He began to speak and could walk unassisted by the end of July.(ABSTRACT TRUNCATED AT 250 WORDS)