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Abulia: No Will, No Way: SM Hastak, Pooja S Gorawara, NK Mishra
Abulia: No Will, No Way: SM Hastak, Pooja S Gorawara, NK Mishra
Abstract
Abulia refers to impaired ability to perform voluntary actions, show initiative, make decisions along with
decrease in movements, speech, thought and emotional reactions. We describe here two patients who developed
this condition following bilateral insult to different sites in the centromedial core of the brain, the first following
the cerebral venous thrombosis and the second after the right ACA and MCA infarct. Both these patients
improved following treatment with Bromocriptine. These cases are described for proper identification and
management by the clinicians.
1. Site of Lesion Bilaterally centromedial core of Dominant frontal, parietal and Bilateral functional lesions in the
the brain (reduced dopaminergic temporal lobe. antero frontal and temporal
acivity) lobes and caudate nuclei.
2. Nature of disorder Disorder of behavior and initiative Disorder of language Disorder of mood
3. Clinical picture Looks away, stares emptily, appears Smiles at others and attempts to Patient appears persistently sad,
to be in a daze , Miller fishers communicate. anxious, often tearful and
telephone effect is present. conveys feelings of hopelessness
and pessimism.
4. Patients performance Is PARADOXICAL - may suddenly Performance improves with Patient usually responds with
express topic of concern in complete stimulation, worsens with factors latency and all movements are
grammatical language animatedly such as fatigue and noise. Patient slow and halfhearted.
and then revert back to quiet state improvement is gradual and
and surprising everyone for few usually performs to his utmost
seconds. However, overall does not potential.
perform despite potential
5. Patient co-operation Patient refuses to Cooperate for Patient usually co-operates well Patients co-operation may vary
formal testing despite potential. and attempts all forms of with degree of depression,
Patient would usually turn away objective testing to the best of his current mood and clinicians
from the clinician ignoring him potential. choice of activity. patient
completely. appears disinterested and unable
to concentrate.
6. Indication of needs Doesnt indicate even basic needs Indicates basic and other needs Indicates basic and personal
such as hunger, toilet and doesnt with use of whichever modality needs depending on mood.
even respond to pain. possible, socializes appropriately.
Announcement
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