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Dear Editor: This 13-year-old boy presented with a 4-month history of progressive headaches, vertigo, and blurred vision. At the initial presentation, he showed minor cerebellar ataxia with bilateral papillary edema. There were no further neurological deficits. The cranial MRI scan revealed a vermian fourth ventricular space-occupying lesion consistent with a medulloblastoma causing obstructive hydrocephalus. He had a right ventriculoperitoneal shunt with a medium-pressure valve inserted. The postoperative course was uneventful. One month later, a suboccipital median craniectomy approach was performed (in prone position) to remove the tumor. The histological examination revealed a medulloblastoma. The patient was asymptomatic for the first 2 days. However, on the third postoperative day, he developed significant reduced spontaneous speech and voluntary activity, concentration deficits, and drooling. These symptoms were in agreement with the diagnosis of cerebellar mutism. Laboratory examination revealed no abnormalities related to these symptoms. The postoperative CT scan demonstrated some edema without residual tumor, infarction, or bleeding in the primary site.

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