Intermittent clinical course of akinetic mutism is very unusual. We describe a 74-year-old man who started to demonstrate episodes of altered mental state with stopped moving and talking, poor response to commands, and muscle stiffness in both upper limbs approximately 1.5 months after cardioembolic bilateral paramedian thalamic infarction. Their frequency gradually increased and poststroke nonconvulsive status epilepticus was suspected, but prolonged video-electroencephalography monitoring did not reveal any epileptiform abnormalities. The patient had no significant metabolic or infectious disorders. Thus, upon exclusion of other causes his condition was considered as intermittent akinetic mutism, which was indirectly confirmed by good response of symptoms to amantadine therapy and their recurrence upon termination of this treatment. J. Med. Invest. 71 : 306-309, August, 2024.
Keywords: Akinetic mutism; Bilateral paramedian thalamic infarction; Differential diagnosis; Intermittent clinical course; Treatment.