Cerebral Vascular Disease and Behavior

THERE are two different conditions to which the term akinetic mutism or 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,