2. Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, Maywood, Illinois, USA.
The supplementary motor area (SMA-proper) is important for the programming and execution of motor, speech, and other elaborative functions. Unilateral SMA syndrome is well described. We present two patients who underwent resection of a large parasagittal meningioma in proximity to the SMA-proper in both hemispheres. Following surgery, these patients developed akinetic mutism; the maximal clinical deficit was not immediately evident, but manifested at 48 hours and 1 week respectively. Both patients showed complete recovery of neurological function but the process was slow. Initial return to near normal function was noted at approximately 3 months with a specific pattern; return of strength was first noted in the upper extremities followed by the lower extremities and speech and cognitive function was the last to recover. The unique occurrence of akinetic mutism secondary to bilateral SMA involvement by parasagittal meningiomas of the posterior frontal region is rare. We discuss the clinical and neuropsychological outcomes in these patients along with an analysis of the possible underlying neurophysiological mechanisms of this unique phenomenon.
Keywords: Akinetic mutism, bilateral SMA syndrome, supplementary motor area, parasagittal meningioma