A case of ruptured anterior communicating artery aneurysm with injury to the corpus callosum and cingulate gyrus resulting in akinetic mutism suggests that selected patients may benefit from pharmacological intervention with amantadine, though further research is needed to clarify its efficacy and safety following non-traumatic brain injury.
Aneurysmal subarachnoid haemorrhage (aSAH) can be complicated by multiple secondary conditions including rebleeding, hydrocephalus, infection, and secondary brain injury.
Brain imaging revealed severe injury to the corpus callosum and cingulate gyrus following the ruptured aneurysm.
The patient developed akinetic mutism characterized by severely reduced initiative and an inability to communicate needs, resulting in complete dependence.
Pharmacological treatment with amantadine was used in this case and was associated with observed improvement, though the contribution relative to rehabilitation and spontaneous recovery could not be determined.
Individualised and sustained rehabilitation was identified as important in the management of patients with akinetic mutism following aSAH.
This research presents a case report of a young man in his thirties who suffered a burst blood vessel aneurysm near the front of the brain, leading to bleeding around the brain (subarachnoid haemorrhage). The bleeding caused severe damage to deep brain structures — specifically the corpus callosum (which connects the two brain hemispheres) and the cingulate gyrus (involved in motivation and communication) — resulting in a condition called akinetic mutism. This condition left him with almost no ability to initiate actions or communicate, making him completely dependent on others for care. The case illustrates how difficult it can be to assess and treat patients who show minimal responsiveness after brain injury. The clinical team used a drug called amantadine, which is sometimes used to promote recovery after traumatic brain injuries, alongside an individualised rehabilitation program. The patient showed improvement over time, though the authors acknowledge this could reflect the natural recovery process, the effects of rehabilitation, or a contribution from the amantadine — it is impossible to separate these factors in a single case report. This research suggests that amantadine may have a role to play in helping some patients recover from severe non-traumatic brain injuries like this one, but the evidence from a single case is limited. The authors emphasize that more formal research — such as clinical trials — is needed to properly understand whether amantadine is effective and safe for this type of patient, as current evidence is largely based on traumatic brain injury rather than bleeding caused by aneurysm rupture.
Østgård H, Majewska P, Kvistad K, Hokstad A. (2026). [Not Available].. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. https://doi.org/10.4045/tidsskr.25.0339