Akinesia after Ventriculography—A Contribution to Ego Psychology and the Problem of Sleep

Stages of peculiar and complete akinesia occurred in seven patients after the third ventricle had been filled with air. All seven patients had brain tumors localized around the third ventricle. The neurological findings were similar in all the cases and ventriculography revealed internal hydrocephalus of high degree in all of them. The third ventricle was always partially filled with air, the fourth ventricle was never filled. Immediately following the ventriculography, a manifest akinesia occurred. The akinetic patients did not move spontaneously; even the eyes were not moved and the winking reflexes were not obtainable. The patients could not eat unassisted and were incontinent of fæces and urine. Yet their consciousness was undisturbed; they were able to answer questions and could give information about their feelings, experiences and dreams.

Slight atrophy of the frontal lobes was present in all of the seven cases, but this damage alone was not responsible for the occurrence of the akinesia. The akinesia was different from the akinetic syndrome due to extra-pyramidal processes. The x-ray findings, the neurological symptoms, other pathological symptoms and the autopsy of one of the cases support the opinion that the underlying pathological process, which may be considered as being the cause of the akinesia, may be localized in the hypothalamic region. This localization is confirmed by neuropathological studies of encephalitic patients suffering from a similar kind of akinesia.