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April 1987

Akinetic Mutism in a Bone Marrow Transplant Recipient Following Total-Body Irradiation and Amphotericin B Chemoprophylaxis: A Positron Emission Tomographic and Neuropathologic Study

Author Affiliations

From the Department of Neurology, Memorial Sloan-Kettering Cancer Center (Drs Lemann, Moeller, and Rottenberg), the Department of Neurology, Cornell University Medical College (Dr Devinsky), New York, and the Brain Imaging Center, Montreal Neurological Institute and Hospital, Montreal (Dr Evans).

Arch Neurol. 1987;44(4):414-417. doi:10.1001/archneur.1987.00520160048013

• We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A trial of high-dose bromocriptine did not stimulate purposeful verbal or motor activity. Fluorine 18-fluorodeoxyglucose positron emission tomographic studies, performed before and during bromocriptine therapy, demonstrated cerebral hypometabolism and treatment-related decreases in regional cerebral blood volume. We conclude that whole-brain or total-body irradiation may increase blood-brain barrier permeability to polyene antibiotics, and that high-dose therapy with dopamine agonists is unlikely to benefit patients with akinetic mutism due to diffuse whitematter lesions.