Thitikan Wangapakul, Abdel Raouf Kayssi, Ambar Elizabeth Moguel Riley
{"title":"Akinetic mutism following bilateral parasagittal meningioma occupied supplementary motor area removal and the spontaneous recovery of symptoms.","authors":"Thitikan Wangapakul, Abdel Raouf Kayssi, Ambar Elizabeth Moguel Riley","doi":"10.25259/SNI_130_2024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Resection of bilateral parasagittal meningiomas of the dominant cortex is challenging. Some postoperative consequences are difficult to predict due to their low incidence. However, it is essential to recognize reversible symptoms. Akinetic mutism is a devastating but reversible symptom that occurs after supplementary motor area (SMA) injury. This report aims to provide more information to support the clinical progression of this syndrome.</p><p><strong>Case description: </strong>A 47-year-old woman presented with psychomotor retardation and subtle weakness, particularly on the left side. A palpable mass was identified at the head vertex. Magnetic resonance imaging revealed bilateral parasagittal meningiomas with bone and sinus invasion of the SMA. A craniotomy was performed to remove the intracapsular tumor. Two days after the operation, the patient developed gradual deterioration in her motor function until it became a lock-in-like syndrome. Then, 1.5 months after treatment in the hospital and rehabilitation unit, she gradually improved her motor, cognitive, and psychomotor skills. Total recovery was achieved after 1 year.</p><p><strong>Conclusion: </strong>Surgery for lesions involving bilateral SMA can cause akinetic mutism. The typical manifestation of this syndrome may be devastating. However, it is reversible, and patients can regain full motor and cognitive functions over time without specific treatments. It is crucial to persevere and continue to provide the best care to the patient until recovery.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11090544/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical neurology international","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25259/SNI_130_2024","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Resection of bilateral parasagittal meningiomas of the dominant cortex is challenging. Some postoperative consequences are difficult to predict due to their low incidence. However, it is essential to recognize reversible symptoms. Akinetic mutism is a devastating but reversible symptom that occurs after supplementary motor area (SMA) injury. This report aims to provide more information to support the clinical progression of this syndrome.
Case description: A 47-year-old woman presented with psychomotor retardation and subtle weakness, particularly on the left side. A palpable mass was identified at the head vertex. Magnetic resonance imaging revealed bilateral parasagittal meningiomas with bone and sinus invasion of the SMA. A craniotomy was performed to remove the intracapsular tumor. Two days after the operation, the patient developed gradual deterioration in her motor function until it became a lock-in-like syndrome. Then, 1.5 months after treatment in the hospital and rehabilitation unit, she gradually improved her motor, cognitive, and psychomotor skills. Total recovery was achieved after 1 year.
Conclusion: Surgery for lesions involving bilateral SMA can cause akinetic mutism. The typical manifestation of this syndrome may be devastating. However, it is reversible, and patients can regain full motor and cognitive functions over time without specific treatments. It is crucial to persevere and continue to provide the best care to the patient until recovery.
背景:切除双侧优势皮层矢状旁脑膜瘤具有挑战性。由于发病率低,一些术后后果很难预测。然而,识别可逆的症状至关重要。动眼神经缄默症是补充运动区(SMA)损伤后出现的一种破坏性但可逆的症状。本报告旨在为该综合征的临床进展提供更多信息支持:一名 47 岁的女性出现精神运动迟缓和细微无力,尤其是左侧。头顶部发现一个可触及的肿块。磁共振成像显示,双侧矢状旁脑膜瘤伴有SMA的骨和窦侵犯。患者接受了开颅手术,切除了囊内肿瘤。术后两天,患者的运动功能逐渐减退,直至出现锁定样综合征。在医院和康复科治疗 1 个半月后,她的运动、认知和精神运动能力逐渐改善。一年后,她完全康复:结论:双侧 SMA 病变手术可导致动眼神经缄默症。结论:涉及双侧 SMA 的病变手术可导致动眼神经缄默症,这种综合征的典型表现可能是毁灭性的。然而,它是可逆的,患者无需特殊治疗即可逐渐恢复全部运动和认知功能。关键是要坚持不懈,继续为患者提供最佳护理,直至康复。