Akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A positron emission tomographic and neuropathologic study.
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.
D000328:Adult; D000405:Akinetic Mutism / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D000666:Amphotericin B / Q000009:adverse effects*; D000741:Anemia, Aplastic / Q000628:therapy; D016026:Bone Marrow Transplantation; D001971:Bromocriptine / Q000627:therapeutic use; D002560:Cerebrovascular Circulation; D003847:Deoxyglucose / Q000031:analogs & derivatives; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D008297:Male; D014055:Tomography, Emission-Computed; D014916:Whole-Body Irradiation / Q000009:adverse effects*
D019788:Fluorodeoxyglucose F18; D001971:Bromocriptine; D000666:Amphotericin B; D003847:Deoxyglucose; D005947:Glucose