Disclosures: Mina S. Gayed, DO: Nothing to disclose

Case Description: Patient was admitted to acute rehabilitation after suffering a subarachnoid hemorrhage, intraventricular hemorrhage, and bilateral anterior communicating artery (ACA) territory strokes due to a ruptured anterior communicating artery aneurysm which was subsequently embolized. On admission, he was tetraplegic and aphonic. He was able to track people in his environment with his eyes, had limited movement of his head, and appeared locked-in. Based on the bilateral ACA distribution of the stroke, he was diagnosed with akinetic mutism, a rare insult to the frontosubcortical circuitry resulting in a state of wakefulness characterized by severely reduced spontaneous behaviors. Very limited improvement was seen with Amantadine. Upon initiation and uptitration of Sinemet, the patient became more interactive with his environment. His range of facial expressions increased. He became able to mouth certain words and obtained wrist movements, and grasp reflex. He became able to answer questions with whispers and verbalizations and correctly stated the identity of a family member at his side. Furthermore, he was switched to an oral diet after previously having been receiving tube feedings. Upon completion of his acute rehabilitation, he was discharged to a brain injury specialized subacute rehabilitation center.

Setting: Inpatient rehabilitation brain trauma unit

Patient: A 50-year-old hypertensive male with akinetic mutism after stroke.

Assessment/Results: At about 9 weeks post injury, the patient became more interactive with his environment upon initiation of Sinemet.

Discussion: Our case adds to the limited amount of reports of this rare diagnosis. There are only 21 published cases. The mesocortical dopaminergic pathway was injured due to his strokes which explains why he improved steadily once Sinemet was started.

Conclusion: Further research into akinetic mutism will need to be carried out before definitively determining the appropriate standard of care. Further education for care providers is necessary not to confuse akinetic mutism with a disorder of consciousness or locked-in syndrome.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-rare-diagnosis-of-akinetic-mutism-and-its-difficulty-in-detection-a-case-report/