Background: Mutism and dense retrograde amnesia are found both in organic and dissociative contexts. Moreover, dissociative symptoms may be modulated by right prefrontal activity. A single case, M.R., developed left hemiparesis, mutism and retrograde amnesia after a high-voltage electric shock without evidence of lasting brain lesions. M.R. suddenly recovered from his mutism following a mild brain trauma 2 years later. Methods: M.R.’s neuropsychological pattern and anatomoclinical correlations were studied through (i) language and memory assessment to characterize his deficits, (ii) functional neuroimaging during a standard language paradigm, and (iii) assessment of frontal and left insular connectivity through diffusion tractography imaging and transcranial magnetic stimulation. A control evaluation was repeated after recovery. Findings: M.R. recovered from the left hemiparesis within 90 days of the accident, which indicated a transient right brain impairment. One year later, neurobehavioral, language and memory evaluations strongly suggested a dissociative component in the mutism and retrograde amnesia. Investigations (including MRI, fMRI, diffusion tensor imaging, EEG and r-TMS) were normal. Twenty-seven months after the electrical injury, M.R. had a very mild head injury which was followed by a rapid recovery of speech. However, the retrograde amnesia persisted. Discussion: This case indicates an interaction of both organic and dissociative mechanisms in order to explain the patient’s symptoms. The study also illustrates dissociation in the time course of the two different dissociative symptoms in the same patient.

Maguire M, Seidi O, Baker M, Gupta A, Muwanga C: Acute mutism: a useful lesson. Emerg Med J 2011;28:82–83.
Kim YW, Shin JC, An YS: Treatment of chronic akinetic mutism with atomoxetine: subtraction analysis of brain 18F-fluorodeoxyglucose positron emission tomographic images before and after medication: a case report. Clin Neuropharmacol 2010;33:209–211.
Jacobsen T: Case study: is selective mutism a manifestation of dissociative identity disorder? J Am Acad Child Adolesc Psychiatry 1995;34:863–866.
Altshuler LL, Cummings JL, Mills MJ: Mutism: review, differential diagnosis, and report of 22 cases. Am J Psychiatry 1986;143:1409–1414.
Turkstra LS, Bayles KA: Acquired mutism: physiopathy and assessment. Arch Phys Med Rehabil 1992;73:138–144.
Nagaratnam N, Fanella S, Gopinath S, Goodwin A: Prolonged abulia following putaminal hemorrhage. J Stroke Cerebrovasc Dis 2001;10:92–93.
Thorpe LU, Keegan DL, Veeman GA: Conversion mutism: case report and discussion. Can J Psychiatry 1985;30:71–73.
Sirois F: Hysterical mutism associated with a diagnosis of lung cancer. Psychosomatics 2007;48:452–453.
Kalman TP, Granet RB: The written interview in hysterical mutism. Psychosomatics 1981;22:362–363, 366.
Brand M, Eggers C, Reinhold N, Fujiwara E, Kessler J, Heiss WD, et al: Functional brain imaging in 14 patients with dissociative amnesia reveals right inferolateral prefrontal hypometabolism. Psychiatry Res 2009;174:32–39.
Ramasubbu R: Conversion sensory symptoms associated with parietal lobe infarct: case report, diagnostic issues and brain mechanisms. J Psychiatry Neurosci 2002;27:118–122.
Ersahin Y, Yararbas U, Duman Y, Mutluer S: Single photon emission tomography following posterior fossa surgery in patients with and without mutism. Childs Nerv Syst 2002;18:318–325.
Ersahin Y: SPECT in cerebellar mutism. Childs Nerv Syst 1998;14:611–613.
Ersahin Y: Is splitting of the vermis responsible for cerebellar mutism? Pediatr Neurosurg 1998;28:328.
Kikuchi H, Fujii T, Abe N, Suzuki M, Takagi M, Mugikura S, et al: Memory repression: brain mechanisms underlying dissociative amnesia. J Cogn Neurosci 2010;22:602–613.
Kleinschmidt-DeMasters BK: Neuropathology of lightning-strike injuries. Semin Neurol 1995;15:323–328.
Cooper MA: Emergent care of lightning and electrical injuries. Semin Neurol 1995;15:268–278.
Freeman CB, Goyal M, Bourque PR: MR imaging findings in delayed reversible myelopathy from lightning strike. AJNR Am J Neuroradiol 2004;25:851–853.
Cherington M, Yarnell PR, London SF: Neurologic complications of lightning injuries. West J Med 1995;162:413–417.
Cherington M: Spectrum of neurologic complications of lightning injuries. NeuroRehabilitation 2005;20:3–8.
Kopelman MD, Wilson BA, Baddeley AD: The Autobiographical Memory Interview: a new assessment of autobiographical and personal semantic memory in amnesic patients. J Clin Exp Neuropsychol 1989;11:724–744.
Wixted JT: On common ground: Jost’s (1897) law of forgetting and Ribot’s (1881) law of retrograde amnesia. Psychol Rev 2004;111:864–879.
O’Bryant SE, Gavett BE, McCaffrey RJ, O’Jile JR, Huerkamp JK, Smitherman TA, Humphreys JD: Clinical utility of Trial 1 of the Test of Memory Malingering (TOMM). Appl Neuropsychol 2008;15:113–116.
Maeder PP, Meuli RA, Adriani M, Bellmann A, Fornari E, Thiran JP, et al: Distinct pathways involved in sound recognition and localization: a human fMRI study. Neuroimage 2001;14:802–816.
Cronholm B, Lagergren A: Memory disturbances after electroconvulsive therapy. 3. An experimental study of retrograde amnesia after electroconvulsive shock. Acta Psychiatr Scand 1959;34:283–310.
Meeter M, Murre JM, Janssen SM, Birkenhager T, van den Broek WW: Retrograde amnesia after electroconvulsive therapy: a temporary effect? J Affect Disord 2011;132:216–222.
Squire LR, Slater PC, Miller PL: Retrograde amnesia and bilateral electroconvulsive therapy. Long-term follow-up. Arch Gen Psychiatry 1981;38:89–95.
Calev A, Gaudino EA, Squires NK, Zervas IM, Fink M: ECT and non-memory cognition: a review. Br J Clin Psychol 1995;34:505–515.
Akhtar S, Buckman J: The differential diagnosis of mutism: a review and a report of three unusual cases. Dis Nerv Syst 1977;38:558–563.
Reinhold N, Markowitsch HJ: Emotion and consciousness in adolescent psychogenic amnesia. J Neuropsychol 2007;1:53–64.
Christensen JA, Sherman RT, Balis GA, Wuamett JD: Delayed neurologic injury secondary to high-voltage current, with recovery. J Trauma 1980;20:166–168.
De Lange FP, Toni I, Roelofs K: Altered connectivity between prefrontal and sensorimotor cortex in conversion paralysis. Neuropsychologia 2010;48:1782–1788.
Ouellet J, Rouleau I, Labrecque R, Bernier G, Scherzer PB: Two routes to losing one’s past life: a brain trauma, an emotional trauma. Behav Neurol 2008;20:27–38.
Cojan Y, Waber L, Carruzzo A, Vuilleumier P: Motor inhibition in hysterical conversion paralysis. Neuroimage 2009;47:1026–1037.
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