Post Stroke Abulia: A Case Report of Fronto-Subcortical Circuit Dysfunction

Abstract

Background: Abulia is a disorder of diminished motivation characterized by reduced speech, reduced spontaneous activity, and emotional unresponsiveness.

It is commonly associated with lesions involving frontal-subcortical circuits. We report a 79-year-old female with type 2 diabetes mellitus who presented with progressive reduction in speech, responsiveness, and spontaneous activity associated with a fall. MRI brain showed a left gangliocapsular infarct. Initially treated as post-stroke metabolic encephalopathy, the patient showed no improvement in clinical status with deficit disproportionate to the infarct. Persistent apathy, reduced initiation, and diminished speech led to the diagnosis of post-stroke abulia. Treatment with amantadine and levodopa-carbidopa resulted in clinical improvement. This case highlights the importance of early recognition of abulia as a treatable complication of stroke and the role of dopaminergic therapy in improving outcomes.