Mutisme akinétique et lésion bipallidale après intoxication médicamenteuse à l’hydroxyzine. À propos d’un cas

Abstract

AimsWhen managing a suicide-attempting patient, the psychiatrist needs to exclude all possibilities of neurological sequellae that might alter or explain the psychiatric presentation. MethodsWe present a case-study of intentional hydroxyzine poisoning and a review of the literature on akinetic mutism (AM) and bilateral pallidal lesion (BPL). ResultsThis case illustrates a clinical situation in which cerebral imagery reoriented the psychiatric management in favour of neurological rehabilitation treatment. The language disturbance, initially interpreted as a manifestation of psychotic negativity, evolved following the discontinuation of the usual treatment from mutism to motor aphasia. Cerebral MRI concluded to a recent BPL. Retrospective interpretation of the initial clinical presentation led to the diagnosis of AM secondary to post-anoxia encephalopathy. DiscussionAM, first described in 1943, is not well-known among psychiatrists, since it belongs to the area of neurology. Yet this diagnosis enables an accurate description of our patient's behaviour. AM is distinct from catatonia by way of certain behavioural features, but above all by the absence of any psychopathological development. This raises the issue of the anatomical-clinical correlation between a behavioural manifestation and a detectable lesion. The causal relationship between the clinical semiology of MA and the radiological semiology of BPL is compromised by the clinical polymorphism of patients with BPL and the anatomical or radiological polymorphism of AM. ConclusionLike catatonia, AM raises the question of the borderline between neurology and psychiatry. The poor anatomical-clinical correlation and the prognostic uncertainty suggest the need to reappraise AM from a psychopathological and nosographic viewpoint.