Akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A positron emission tomographic and neuropathologic study.

Abstract

We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A trial of high-dose bromocriptine did not stimulate purposeful verbal or motor activity. Fluorine 18-fluorodeoxyglucose/positron emission tomographic studies, performed before and during bromocriptine therapy, demonstrated cerebral hypometabolism and treatment-related decreases in regional cerebral blood volume. We conclude that whole-brain or total-body irradiation may increase blood-brain barrier permeability to polyene antibiotics, and that high-dose therapy with dopamine agonists is unlikely to benefit patients with akinetic mutism due to diffuse white-matter lesions.

• Authors: O Devinsky, W Lemann, A C Evans, J R Moeller, D A Rottenberg
• Journal: Archives of neurology (Arch Neurol) Vol. 44 Issue 4 Pg. 414-7 (Apr 1987) ISSN: 0003-9942 [Print] United States
• PMID: 3548667 (Publication Type: Case Reports, Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Fluorodeoxyglucose F18
• Bromocriptine
• Amphotericin B
• Deoxyglucose
• Glucose

Topics

• Adult
• Akinetic Mutism (etiology, metabolism, pathology)
• Amphotericin B (adverse effects)
• Anemia, Aplastic (therapy)
• Bone Marrow Transplantation
• Bromocriptine (therapeutic use)
• Cerebrovascular Circulation
• Deoxyglucose (analogs & derivatives)
• Fluorodeoxyglucose F18
• Glucose (metabolism)
• Humans
• Male
• Tomography, Emission-Computed
• Whole-Body Irradiation (adverse effects)