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May 1970

Cerebral Vascular Disease and Behavior: The Syndrome of the Mesencephalic Artery (Basilar Artery Bifurcation)

Author Affiliations

From the Department of Neurology, Boston University School of Medicine, and the Boston Veterans Administration Hospital, Boston.

Arch Neurol. 1970;22(5):408-418. doi:10.1001/archneur.1970.00480230026003

THERE are two different conditions to which the term akinetic mutism or vigilant coma are properly applied. In one form of akinetic mutism the patient lies in bed, immobile yet seemingly alert, ready to be aroused, and to follow with his gaze whatever events happen in the visual fields; there is no evidence of oculomotor paralysis. This state of inertia can be interrupted in such patients by brief bouts of excitement, restlessness, and motor agitation. If stimulated enough, they may react with a word or two. This is a state best described as "hyperpathic" akinetic mutism or, if the term "coma" is to be used, this is a state of "vigilant" coma.

In the other form, the patient is apathetic and somnolent most of the time. When he opens his eyes, he may keep them open if stimulation is sustained by calling the patient by name, pinching him, etc,

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