On the pathophysiology and treatment of akinetic mutism

Arnts, Hisse; Erp, Willemijn S. van; Lavrijsen, Jan C. M.; Gaal, Simon van; Groenewegen, Henk J.; Munckhof, Pepijn van den

doi:10.1016/j.neubiorev.2020.02.006

Cited by 52 publications

(44 citation statements)

References 109 publications

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“…Akinetic mutism has been described in a COVID-19 case report, lasting 5 days [20], and in a case-series of 4 patients [21]; all 5 patients had frontal FDG-PET hypometabolism, while CSF and MRI findings were normal [20,21]. Akinetic mutism is typically associated with frontal lobe injury [22], and we indeed observed frontal lobe abnormalities, including a small frontal lobe cortical subarachnoid hemorrhage in one patient and FIRDA in 3 of 4 patients investigated with EEG, while MRI in 3 and CSF in 2 patients were unremarkable. Seven of our 8 patients had long ICU admissions (median 21 days) and sepsis with multiorgan injury, and all had delirium.…”

Section: Discussionmentioning

confidence: 99%

Central and peripheral nervous system complications of COVID-19: A prospective tertiary center cohort with 3-month follow-up

Nersesjan

Amiri

Lebech

et al. 2020

Preprint

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ObjectiveTo systematically describe CNS and PNS complications in hospitalized COVID-19 patients.MethodsWe conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission, at discharge and at 3-month follow-up. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related.ResultsFrom April-September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom were referred to ICU for respiratory failure. Evaluation revealed a higher frequency of CNS/PNS symptoms in ICU patients compared to non-ICU patients. The most common CNS complication was encephalopathy (n=22, 36.1%), which was severe in 13 patients (GCS≤12), including 8 with akinetic mutism. Length of ICU admission was an independent predictor of encephalopathy (OR=1.23). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR=1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were classified as para/post-infectious. The remainder included cases secondary to critical illness or other causes (n=34) or without sufficient investigations (n=4). Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated.ConclusionsCNS/PNS complications were common in hospitalized COVID-19 patients, particularly in ICU patients, and often attributable to critical illness. In cases with COVID-19 as the primary cause for neurological disease, there were no signs of viral neurotropism, but laboratory changes suggested autoimmune-mediated mechanisms.

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Section: Discussionmentioning

confidence: 99%

Central and peripheral nervous system complications of COVID-19: A prospective tertiary center cohort with 3-month follow-up

Nersesjan

Amiri

Lebech

et al. 2020

Preprint

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“…Akinetic mutism has been described in a COVID-19 case report, lasting 5 days [22], and in a case series of 4 patients [23], all 5 patients had frontal FDG-PET hypometabolism, while CSF and MRI findings were normal [22,23]. Akinetic mutism is typically associated with frontal lobe injury [24], and we indeed observed frontal lobe abnormalities, including a small frontal lobe cortical subarachnoid hemorrhage in one patient and FIRDA in 3 of 4 patients investigated with EEG, while MRI in 3 and CSF in 2 patients were unremarkable. Seven of our 8 patients had long ICU admissions (median 21 days) and sepsis with multiorgan injury, and all had delirium.…”

Section: Encephalopathymentioning

confidence: 94%

Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up

et al. 2021

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Objective To systematically describe central (CNS) and peripheral (PNS) nervous system complications in hospitalized COVID-19 patients. Methods We conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission and discharge. Three-month follow-up data were collected using electronic health records. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related. Results From April to September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom required intensive care (ICU) management for respiratory failure. Forty-one CNS/PNS complications were identified in 28 of 61 (45.9%) patients and were more frequent in ICU compared to non-ICU patients. The most common CNS complication was encephalopathy (n = 19, 31.1%), which was severe in 13 patients (GCS ≤ 12), including 8 with akinetic mutism. Length of ICU admission was independently associated with encephalopathy (OR = 1.22). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR = 1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were para/post-infectious, 34 were secondary to critical illness or other causes, and 4 remained unresolved. Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated. Conclusion CNS and PNS complications were common in hospitalized COVID-19 patients, particularly in the ICU, and often attributable to critical illness. When COVID-19 was the primary cause for neurological disease, no signs of viral neurotropism were detected, but laboratory changes suggested autoimmune-mediated mechanisms.

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“…Akinetic mutism, catatonia, and Parkinsonism have many similarities and due to clinical heterogeneity they are difficult to set apart from each other and to adequately diagnose. A recent review done by Arnts and colleagues tried to summarize the neuropathophysiological and neuroanatomical localization for akinetic mutism and possible treatment strategies [15]. Despite advances made in recent years in understanding of the neuroanatomy, neuro-physiology, and chemoarchitecture of neurocircuits that are involved in the initiation and motivation of behavior, it is still not fully understood [15].…”

Section: Discussionmentioning

confidence: 99%

Pneumocephalus and Catatonia in a Patient With Persistent Drain Dysfunctions and Infections After a Hydrocephalus due to an Aquaduct Stenosis: A Case Report

Pouwels

Vis

Ramnarain

et al. 2020

Cureus

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The combination of catatonia and pneumocephalus is very rare and literature is very scarce on this topic. Here, we report a patient with pneumocephalus and catatonia after persistent drain dysfunctions and infections after a hydrocephalus due to an aquaduct stenosis. The combination of a catatonic syndrome and pneumocephalus in neurosurgical and intensive care practice is a rare phenomenon. One should consider it in patients after complicated neurosurgery with pneumocephalus.

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On the pathophysiology and treatment of akinetic mutism

Cited by 52 publications

References 109 publications

Central and peripheral nervous system complications of COVID-19: A prospective tertiary center cohort with 3-month follow-up

Central and peripheral nervous system complications of COVID-19: A prospective tertiary center cohort with 3-month follow-up

Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up

Pneumocephalus and Catatonia in a Patient With Persistent Drain Dysfunctions and Infections After a Hydrocephalus due to an Aquaduct Stenosis: A Case Report

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