Diminution of basal ganglia dopaminergic function may play an important role in the generation of akinetic mutism in a patient with anterior cerebral arterial infarct.
We report the clinical features and dopamine transporter [2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo[3.2.1]oct-2-yl]methyl](2-mercaptoethyl)amino]ethyl]amino]ethanethiolato(3-)-N2,N20,S2,S20]oxo-[1R-(exo-exo)]-[99mTc] technetium([99mTc]TRODAT-1) image finding in an 86-year-old woman with akinetic mutism due to infarction of bilateral anterior cerebral arterial territories. TRODAT-1 is a cocaine analogue that can be labeled with technetium-99m and bound to the dopamine transporter (DAT) site. It reflects primarily the integrity of presynaptic dopamine neuron terminals. With the evolution of the clinical features, the TRODAT SPECT images change from bilateral diminution of radioactivity uptake at the 81st-day check point to normal pattern at the 6-month one when the akinetic mute manifestations were nearly gone. This novel illustration suggests that the akinetic mutism caused by anterior cerebral arterial infarct is closely linked to the perturbation of the subcortical dopaminergic system. And the amelioration of the clinical features concordantly evolved with the restoration of the dopaminergic function.
Yang
Chun-Pai
CP
Department of Neurology, China Medical University Hospital, 2 Yuh-Der Road, Taichung 404, Taiwan.
Huang
Wei-Shih
WS
Shih
Hsu-Tzu
HT
Lin
Chun-Yi
CY
Lu
Ming-Kuei
MK
Kao
Chia-Hung
CH
Hsieh
Te-Chun
TC
Huang
Kai-Ju
KJ
Lee
Ying-Hsuan
YH
Tsai
Chon-Haw
CH
D000369:Aged, 80 and over; D000405:Akinetic Mutism / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003342:Corpus Striatum / Q000000981:diagnostic imaging / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D050483:Dopamine Plasma Membrane Transport Proteins / Q000502:physiology*; D005500:Follow-Up Studies; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D009415:Nerve Net / Q000000981:diagnostic imaging / Q000503:physiopathology; D009460:Neurologic Examination; D015609:Organotechnetium Compounds; D011954:Receptors, Dopamine / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes
D050483:Dopamine Plasma Membrane Transport Proteins; D015609:Organotechnetium Compounds; D011954:Receptors, Dopamine; D014326:Tropanes; C104196:technetium Tc 99m TRODAT-1