PubMed1984
A 63 years old man was admitted because of coma of 24 hours duration. He had a history of infarction of the medulla oblongata 7 months earlier. On admission he was unconscious and had right oculomotor nerve palsy. To a painful stimulus, he responded with only a slight body movement. On the CT scan, low density areas were seen in the bilateral thalamus and the midbrain. In the next day he recovered from coma and abnormal behaviors appeared such as wondering in the ward, touching other patient's face and manipulating his stool. Verbal expression was extremely poor. Chlorpromazine was needed to suppress abnormal behaviors. Thereafter, abnormal behaviors gradually subsided and by the 23 hospital day he became bedridden even when chlorpromazine was withdrawn. At that time, he said only "yes" or "no" in response to questions and only few spontaneous movements were observed. From the 40 hospital day he suffered from pneumonia and gradually sank into the state of akinetic mutism. He died on the 50 hospital day. Pathologically, infarctions destroyed the n. parafascicularis, n. centromedianus and the intralaminar nuclei in the left thalamus, n. parafascicularis and a part of n. centromedianus in the right. In the medulla oblongata, right n. ambiguous and reticular formation were destroyed. Both thalamic lesions extended posteriorly to unite with the midbrain lesion.(ABSTRACT TRUNCATED AT 250 WORDS)