Cerebellar mutism following head trauma: A case report and literature review

Abstract

Background: Cerebellar mutism (CM) is defined as the lack of speech production, despite an intact state of consciousness and cognitive function, that happens secondary to a cerebellar insult. To the best of our knowledge, only five cases have thus far been described in the English literature. In this paper, we report the sixth incidence overall, which is also the first case of a CM associated with penetrating head injury. The relevant literature is reviewed and analyzed, our current knowledge of the neuroanatomical and functional relations is summarized, and potential future research endeavors are indicated. Case Description: An 8-year-old girl was transferred to our hospital having had fallen on a rod that penetrated her neck behind the ear. An urgent computed tomography scan of the head revealed a right cerebellar contusion with surrounding edema. Three days later, she became mute but was still obeying commands. Repeat imaging showed a resolving cerebellar contusion with increased edema and mass effect. By day 9, she had uttered a few words. At 1-month follow-up, the child had regained normal speech. Conclusion: Posttraumatic CM is a rare and probably underreported condition with only six documented cases to date. Although it may well be on the same spectrum as postoperative CM, further understanding of the exact mechanism, clinical course, and prognosis of this entity is bound to significantly improve the recovery and quality of life of head trauma patients.

Cerebellar mutism syndrome of non-tumour surgical aetiology—a case report and literature review

“…Eight patients in 7 case reports were identified [ 11 , 18 , 22 , 24 , 25 , 28 , 46 ]. One patient had immediate evacuation of an acute subdural haematoma in the PF; the remaining cases were either treated conservatively (5/8) or treatment was unaccounted for (2/8).…”

“…Makarenko et al [ 29 ] reviewed literature on CMS of non-surgical origin in 2017 finding 20 patients. Lahirish et al [ 28 ] reviewed the literature on CMS in paediatric head trauma in 2021 and included 6 patients. Thus, the current literature review contributes with an updated, comprehensive and collected overview for future reference.…”

Gunshot Wound to the Posterior Fossa With a Transcerebellar Retromesencepahlic Bullet Path, Transient Mutism, and Unexpected Functional Recovery: The Pivotal, Energy-Absorbing Function of the Petrous Bone and Tentorial Leaflet

“…Though cerebellar mutism has most commonly been described in the context of fourth ventricular tumor resections, particularly when an incision is made in the vermis and in children with medulloblastoma [6], this syndrome has only been rarely reported in the setting of trauma (Table 1) and never previously as a result of a GSW to the head [7][8][9][10][11][12]. The exact pathophysiological mechanism of cerebellar mutism remains unclear, though it is generally agreed upon that damage to the cerebello-cerebral pathways is a major contributing factor [6,[13][14][15][16].…”