Resumen: El mutismo acinético es considerado como una alteración del estado motivacional de la persona, por la cual el paciente es incapaz de iniciar respuestas verbales o motoras de carácter voluntario, aún teniendo preservadas las funciones sensoriomotoras y de vigilancia. La lesión, que puede ser vascular, infecciosa, tóxica o degenerativa, incide sobre dos circuitos que podrían estar funcionalmente relacionados: el cortex frontal medial con afectación del cíngulo anterior, o el daño en regiones talámicas y mesencefálicas relacionadas con la formación reticular activadora ascendente. El diagnóstico de mutismo acinético resulta a veces difícil de establecer, y suele confundirse con algunos tipos de afasias o estados de alteración de la conciencia, que tienen un abordaje clínico y un pronóstico notablemente diferentes. Con el objetivo de llevar a cabo un buen diagnóstico diferencial proponemos un protocolo clínico con una evaluación neuropsicológica breve de las funciones que pudieran estar diferencialmente afectadas en todos esos síndromes, como atención, praxias y lenguaje. Exponemos un caso de mutismo evaluado con este protocolo para demostrar su especificidad a la hora de distinguirlo de otras afecciones o síndromes. Palabras clave: mutismo acinético; córtex cingulado anterior; evaluación neuropsicológica; neuropsicología; síndrome frontal.Title: Akinetic Mutism: a review, proposal of neuropsychological protocol to establish a differential diagnosis and its application to a case. Abstract: Akinetic mutism is considered as a disturbance of a person´s motivational state, therefore the patient is unable to initiate verbal or motor responses, although they continue to maintain sensorimotor and vigilant functions. The lesion can be vascular or it can be caused by infections, cerebral degeneration and toxicity. Lesions can influence the functions of two cerebral circuits: the Frontal medial cortex affecting to cingulated cortex, or it can damage the thalamic and mesencephalic regions related to the ascending reticular activating system. It is difficult to diagnose Akinetic Mutism since it can be confused with some types of aphasia and altered states of consciousness, which require different interventions. In order to complete a clinical protocol we recommend a brief neuropsychological evaluation of functions such as attention, praxis and language, all of which could be affected by the syndromes previously named. We expound a case of akinetic mutism evaluated with this protocol in order to show its specificity distinguishing akinetic mustism from other syndromes. Key words: akinetic mutism; anterior cingulate cortex; neuropsychological assesment; neuropsychology; frontal syndrome. Introducción y objetivosEl mutismo acinético (MA) se configura como un síndrome difícil de diagnosticar que, a menudo, se confunde con otras alteraciones neuropsicológicas tales como afasia motora, trastornos atencionales, estados de mínima conciencia o síndrome de cautiverio, entre otros.Nuestro trabajo tiene un doble objetivo. En prime...
Encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (i.e., anti-NMDAR encephalitis) is an immune-mediated disorder mainly affecting girls and young women with ovarian teratoma. The clinical picture of the disease progresses from headaches and seizures, psychopathological symptoms (i.e., anxiety, psychosis, or hyperreligiosity), and neuropsychological deficits (i.e., memory, attention, and language disintegration) into a state of agitation, catatonia, dysautonomia (i.e., abnormal movements due to inappropriate muscular activity) and facial dyskinesia. Reports of the neuropsychological profile and evolution, as well as the neuropsychological rehabilitation in anti-NMDAR encephalitis in the literature are scarce. We present the case of a 21-year-old woman diagnosed with anti-NMDAR encephalitis and we describe the different neuropsychological evaluation tests performed before and after neuropsychological rehabilitation during the acute period. A profile of fronto-subcortical neuropsychological damage was observed, with executive functions and emotional regulation affected.
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