title: Akinetic mutism in bilateral necrotizing leucoencephalopathy after radiation and chemotherapy: electrophysiological and autopsy findings.
abstract: In a patient with akinetic mutism, extensive circumscribed bilateral lesions in the precentral part of the centrum semiovale, due to delayed necrotizing leucoencephalopathy after combined intravenous polychemotherapy and radiation, were found at autopsy. CT and somatosensory evoked potentials were normal and a slow alpha rhythm was present, but there was a lack of EEG desynchronization. Akinetic mutism and the loss of desynchronization in this case are thought to result from interrupted thalamofrontal and extrathalamic reticulofrontal projections and the disconnection of the anterior limbic cortex.
authors.affiliation: Neurologische Klinik, Universitätsspital, Zürich, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Gütling
authors.forename: T
authors.initials: T
authors.lastname: Landis
authors.forename: P
authors.initials: P
authors.lastname: Kleihues
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000473:pathology; D000405:Akinetic Mutism / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D000513:Alpha Rhythm; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior; D016371:Cranial Irradiation / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003711:Demyelinating Diseases / Q000139:chemically induced* / Q000473:pathology; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008408:Mastectomy; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D009336:Necrosis; D013239:Stereotyped Behavior / Q000502:physiology
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate