akinetic silence
Introduction
Introduction Atheistic mutism (AM) is a special type of vegetative state, also known as comavigil, persistent vegetative state, hypersomnia, deep sleep state, awakening syndrome, etc. It tends to be called AM. It was a special disturbance of consciousness reported by Cairns in 1941 when observing a patient with a third ventricle epithelioid cyst, and has since received attention. The basic manifestation is that although there is reflexive limb movement for stimulation, there is no free movement, self-speech and any emotional reaction. There may be spontaneous blinking, gazing, and chasing movements like awakening.
Cause
Cause
This disease is caused by the reticular activation system of the upper brain or thalamus and the damage of the prefrontal-edge system. It can be caused by a variety of reasons. The first case reported by Cairns is the III ventricle epithelioma. Later, the primary brain was reported. Tumor, pineal tumor, metastatic tumor, cerebral vascular disease (thrombosis, brainstem softening, bleeding, etc.). Cervical aneurysm rupture, encephalitis, cerebral hemisphere extensive small softening lesions, hypothalamic surgery, sleeping pills poisoning, etc. can be the cause of this disease. There are different reports on the lesions of this disease (such as corpus callosum, bilateral anterior cingulate gyrus, frontal lobe, frontal ridge, diencephalon, midbrain, bilateral white matter in the cerebral hemisphere). However, it is considered that the damage of the network structure and the edge system is the most prominent, and some people think that it is not the damage of a specific part. Some people refer to the prefrontal-fragment system as the immobile mutism type I (AMS-I type), while those whose damage is mainly located in the midbrain-diencephalon are called type II (AMS-II type). .
In short, the entire function of the cerebral cortex is inhibited. The causes of inhibition can be divided into two categories: one is caused by extensive lesions of the white matter of the cerebral cortex, and the other is damage of the reticular system centered on the brain stem, which secondaryly causes inhibition of the function of the cerebral cortex. However, the destruction of the network structure is the main reason.
Examine
an examination
Related inspection
EEG examination
1, silence: no self-speaking, can not speak, or can speak words in a whisper.
2, limb movement can not: looks like quadriplegia, there are many escape reactions to painful stimuli, no convulsions and sensory disturbances, if the patient activities, how much can be some activities. The inability of the limbs to move is due to disturbance of consciousness. Can be accompanied by pyramidal tract signs, to the brain toughness and other performance.
3, eyeball, chewing and expression movement abnormalities: the patient blinks, the eyeball has a chasing action, there are also fixed, no expression activity is one of its important features. There may be a frowning response to painful stimuli, and the food in the mouth is swallowed without chewing.
4, state of consciousness: more conscious obstacles, after treatment can be restored consciousness, but can not remember the things before the disturbance of consciousness. There are also cases of conscious presence, directed maintenance, or excessive sleep. Sleep and awakening rhythm preservation, most of the stimulation during sleep is easy to wake up, incontinence.
In addition, the symptoms of AMS-I type and type II are slightly different. Type I may have focal signs such as seizures, monoterpene and hemiplegia, sometimes with elevated body temperature, fast pulse, arrhythmia, respiratory rate and rhythm disorder. There are symptoms of autonomic nervous system such as sweating and leukocytosis. Type I may have pupillary changes, eye movement disorders, and vertical movements.
5, EEG: mostly extensive wave and / or wave, and the low voltage fast wave characteristic of brain stem damage is not obvious. Both early and late wave components of somatosensory evoked potentials in severe cases are unlikely to occur.
Diagnosis
Differential diagnosis
In the clinical, the state of being awakened, the content of consciousness, and the way of responding are all considered to be clear. Consciousness disorders are divided into several types: low level of consciousness, altered content of consciousness (), special disturbance of consciousness (no mutism, de-cortical syndrome). There is a difference between the inactive silent (AM) and the de-cortical syndrome in the lesion, but it is difficult to identify it clinically. The main difference between AM and general plant status is that AM can blink or blink under sound stimuli, and the eye can gaze at or move with the object. AM is reversible in clinical practice, and de-cortical syndrome is almost impossible to recover, which can be used to distinguish between the two. On the other hand, AM has specific anatomical sites on the lesion site, and the de-cortical syndrome is a "widespread" lesion, including many anatomical sites with different functions.
1, silence: no self-speaking, can not speak, or can speak words in a whisper.
2, limb movement can not: looks like quadriplegia, there are many escape reactions to painful stimuli, no convulsions and sensory disturbances, if the patient activities, how much can be some activities. The inability of the limbs to move is due to disturbance of consciousness. Can be accompanied by pyramidal tract signs, to the brain toughness and other performance.
3, eyeball, chewing and expression movement abnormalities: the patient blinks, the eyeball has a chasing action, there are also fixed, no expression activity is one of its important features. There may be a frowning response to painful stimuli, and the food in the mouth is swallowed without chewing.
4, state of consciousness: more conscious obstacles, after treatment can be restored consciousness, but can not remember the things before the disturbance of consciousness. There are also cases of conscious presence, directed maintenance, or excessive sleep. Sleep and awakening rhythm preservation, most of the stimulation during sleep is easy to wake up, incontinence.
In addition, the symptoms of AMS-I type and type II are slightly different. Type I may have focal signs such as seizures, monoterpene and hemiplegia, sometimes with elevated body temperature, fast pulse, arrhythmia, respiratory rate and rhythm disorder. There are symptoms of autonomic nervous system such as sweating and leukocytosis. Type I may have pupillary changes, eye movement disorders, and vertical movements.
5, EEG: mostly extensive wave and / or wave, and the low voltage fast wave characteristic of brain stem damage is not obvious. Both early and late wave components of somatosensory evoked potentials in severe cases are unlikely to occur.
