Frontal lobe and cingulate cortical metabolic dysfunction in acquired akinetic mutism: a PET study of the interval form of carbon monoxide poisoning

A middle-aged man suffering from acute carbon monoxide intoxication was clinically assessed to be in an akinetic and mute state. In order to elucidate regional cerebral disturbances, brain metabolism was investigated with fluoro-deoxyglucose positron emission tomography (18FDG-PET) 5.5 months after...

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Vydáno v:Brain injury Ročník 18; číslo 6; s. 615 - 625
Hlavní autoři: Tengvar, Christner, Johansson, Björn, Sorensen, Jens
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Informa UK Ltd 01.06.2004
Taylor & Francis
Témata:
Acute Disease
Adult
Akinetic Mutism - chemically induced
Akinetic Mutism - diagnostic imaging
Akinetic Mutism - metabolism
Carbon Monoxide Poisoning - complications
Fluorodeoxyglucose F18
Frontal Lobe - diagnostic imaging
Frontal Lobe - metabolism
Gyrus Cinguli - diagnostic imaging
Gyrus Cinguli - metabolism
Humans
Male
Radiopharmaceuticals
Tomography, Emission-Computed
ISSN:0269-9052, 1362-301X
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Shrnutí:A middle-aged man suffering from acute carbon monoxide intoxication was clinically assessed to be in an akinetic and mute state. In order to elucidate regional cerebral disturbances, brain metabolism was investigated with fluoro-deoxyglucose positron emission tomography (18FDG-PET) 5.5 months after intoxication. Significantly reduced metabolic rates of glucose were revealed in selected brain regions, especially in both the frontal and anterior cingulate cortices, as well as in the subcortical white matter. Frontal and cingulate cortices showed a preserved metabolism of 35-53%, whereas the regional glucose consumption in cerebral white matter was reduced by more than 70%. In contrast, other areas of the brain such as the sensory-motor cortex, parts of the temporal lobes, basal ganglia and brainstem disclosed normal metabolic values. This lesion topography is discussed in relation to the development of akinetic mutism in the present case and in comparison with recent reports on the topic. Considering a plausible pathophysiology, akinetic mutism appears to be based on a different structural neuropathology when compared with the locked-in syndrome and the vegetative state. It is suggested that akinetic mutism is regarded as a specific condition characterized by injury of the frontal neuronal systems which promote executive functions.
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ISSN:0269-9052
1362-301X
DOI:10.1080/02699050310001622806