Cyanide-induced akinetic rigid syndrome: clinical, MRI, FDG-PET, beta-CIT and HMPAO SPECT findings.
A 35-year-old female ingested a lethal dose of potassium cyanide in a suicide attempt. She survived following antidote therapy and intensive care. Following artificial coma she presented with an agitative state for several days followed by akinetic mutism, buccofacial and ideomotoric aphasia. Severe rigid-akinetic syndrome, dysarthria, dysphagia and generalized dystonia developed weeks later. MRI revealed lesions in the caudate and lentiform nuclei, precentral cortex, and cerebellum. SPECT by [123-I] 2 beta-carbomethoxy-3-beta-(4-iodophenyl)-Tropan on two occasions revealed progressive loss of dopamine transporter suggestive of nigral neuronal apoptosis. Striatal and frontal hypometabolism and hypoperfusion were found by FDG-PET and HMPAO SPECT.
Zaknun
John J
JJ
Department of Neurology, Division of Neuronuclear Medicine and Institute of Neuroradiology, Wagner-Jauregg Hospital, A-4020 Linz, Austria. john.zaknun@tilak.at
Stieglbauer
Karl
K
Trenkler
Johannes
J
Aichner
Franz
F
D000328:Adult; D000405:Akinetic Mutism / Q000139:chemically induced* / Q000175:diagnosis*; D003042:Cocaine / Q000031:analogs & derivatives*; D004421:Dystonia / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D049268:Positron-Emission Tomography; D011190:Potassium Cyanide / Q000506:poisoning*; D013406:Suicide, Attempted; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime; C069723:2beta-carbomethoxy-3beta-(4-iodophenyl)tropane; D003042:Cocaine; D011190:Potassium Cyanide