Akinetic rnutism from hypothalamic damage

A patient with akinetic mutism after surgical removal of a tumor from the anterior hypothalamus responded to treatment with lergotrile and bromocriptine (dopamine receptor agonists) but not to carbidopdl-DOPA or methylphenidate (presynaptic dopamine mimetics). His pharmacologic response was consistent with animal models of hypothalamic-induced akinetic states and suggests that akinesia may be related to loss of dopaminergic input to anterior cingulate cortex or related structures rather than to the striatum.