This 35-year-old woman with history of hypertension, pancreatitis, and idiopathic renal disease developed decreased verbal output, sleepiness, and disorientation within a few days from renal transplantation. She evolved into a state of akinetic-rigid mutism with apraxia of eyelid opening reaching a peak 3 months after recovering from her encephalopathy. She had had a static course thereafter, remaining unresponsive to levodopa and other dopaminergic therapies.

Although our patient was unable to articulate words, she had adequate comprehension of instructions and normal orobuccolingual praxis. She was markedly parkinsonian, virtually akinetic with severe gait and postural impairment. Other deficits included apraxia of eyelid opening, square-wave jerks, inability to initiate horizontal saccades (which themselves were normal) without blinking, and glabellar reflex. Her handwriting was severely micrographic. By the time of her last examination, 2 years after her triggering encephalopathy, she exhibited a moonlike facies from chronic prednisone treatment and an orthopedic cast in both feet placed following tendonectomy to alleviate excessive bilateral plantar flexion.