Akinetic mutism responsive to bromocriptine following subdural hematoma evacuation in a patient with hydrocephalus.
An 11-year-old girl with obstructive hydrocephalus developed akinetic mutism after treatment for hydrocephalus due to aqueductal stenosis by ventriculoperitoneal (VP) shunting. Bilateral chronic subdural hematomas developed about 2 months after insertion of the VP shunt and were evacuated. Postoperatively, the patient developed akinetic mutism, but her condition improved after administration of bromocriptine. Absence of abnormalities on dopamine transporter single photon emission computed tomography, lack of clinical response to levodopa treatment, and normal homovanillic acid concentration in the cerebrospinal fluid all indicated normal dopamine production. Pressure on the periventricular monoamine projections in the thalamus and hypothalamus without major dopamine deprivation in the striatum may have been the most important factors in the development of akinetic mutism in this patient.
Kim
Myoung Soo
MS
Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Jung-gu, ROK. hanibalkms@hanmail.net
Rhee
Jong Joo
JJ
Lee
Seung Jun
SJ
Kwon
Seon-Joo
SJ
Lee
Chae Heuck
CH
D000405:Akinetic Mutism / Q000188:drug therapy* / Q000209:etiology; D001971:Bromocriptine / Q000627:therapeutic use*; D002648:Child; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D046648:Hematoma, Subdural, Intracranial / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000628:therapy*; D011183:Postoperative Complications; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects
D018491:Dopamine Agonists; D001971:Bromocriptine