ArticleJournal of neurosurgery. Case lessons2025
Beyond the triad: akinetic mutism in idiopathic normal pressure hydrocephalus, with response to shunt placement. Illustrative case.
Article in Journal of neurosurgery. Case lessons, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIdiopathic normal pressure hydrocephalus (iNPH) typically manifests with the classic Hakim-Adams triad of gait disturbance, cognitive impairment, and urinary incontinence. While akinetic mutism represents a rare and severe neurological presentation characterized by profound reduction in voluntary movement and speech, its association with iNPH remains underrecognized in clinical practice. This case illustrates both the diagnostic challenges and remarkable therapeutic potential when encountering this unusual manifestation of iNPH. OBSERVATIONS: A previously healthy 52-year-old female developed progressive gait instability, urinary incontinence, and cognitive decline over 6 months, followed by 3 months of akinetic mutism. Examination demonstrated characteristic features of iNPH including paratonic rigidity, magnetic gait, and frontal release signs. Neuroimaging revealed moderate ventriculomegaly with an Evans index of 0.38 and hyperdynamic CSF flow dynamics (peak velocity 7.4 cm/sec, stroke volume 95 µL). The patient exhibited dramatic clinical improvement within 1 week of ventriculoperitoneal shunt placement, with complete resolution of akinetic mutism and significant recovery of other symptoms sustained at the 6-month follow-up. LESSONS: This case underscores that akinetic mutism, while uncommon, may represent a severe but treatable manifestation of iNPH. The rapid reversal of akinetic mutism following CSF diversion highlights the importance of considering iNPH even in atypical presentations. Quantitative CSF flow analysis emerges as a valuable diagnostic tool in such challenging cases, while the striking clinical response reinforces the potential for complete functional recovery with timely intervention. https://thejns.org/doi/10.3171/CASE25257.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.