AKINETIC MUTISM WITH RIGHT HEMIPLEGIA DUE TO AN INFARCT IN THE TERRITORY OF THE LEFT ANTERIOR CEREBRAL-ARTERY

A 65 years old woman with chronic high blood pressure and diabetes mel litus presented with a mutism akinetic of sudden onset and a right tot al hemiplegia with a Babinski sign secondary to a left anterior cerebr al artery infarction. She had had sh months earlier a transient gait d isturbance. At that time, the CT scan showed lacunar infarcts of the t he head of both both caudate nuclei. Neuropathological examination rev ealed that the left infarction of the anterior cerebral artery involve d the superior frontal gyrus, the supplementary motor area, the cingul ate gyrus and the corpus callosum. There were also multiple lacunes of the head of both caudate nuclei, anterior limb of the internal capsul es, white matter, basal ganglia and thalami. The mutism akinetic was t hought to be the result of a bilateral disruption of a functionnal loo p including on each side, the supplementary motor area, the cingulate gyrus, the subcallosal tract and the head of the caudate nucleus. On t he right side, the lesion of the caudate nucleus could have interrupte d this loop normally involved in the induction of voluntary movements and in the communication with the external surroundings.