Cerebellar mutism in an adult: Case report

Çakır, Yasemin; Karakişi, D; Koçanaoğullari, O

doi:10.1016/0090-3019(94)90188-0

Cited by 36 publications

(9 citation statements)

References 5 publications

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“…De fato, na bibliografia compulsada, vários autores não mencionam o acometimento de nervos bulbares associado ao mutismo cerebelar 1,2,8,12,23,24 . No entanto, a lesão de outros nervos cranianos foi observada por alguns estudiosos do assunto, como é o caso dos oculomotores 9,13,25 , do facial 9,13,23-25 e do vestibular 10,12,24,25 .…”

Section: Discussionunclassified

“…No entanto, observa-se mutismo também em adultos operados de tumores cerebelares hemisféricos 23,30 , em pacientes com afecções não neoplásicas 5,10 ou com malformação arteriovenosa em ambos os hemisférios cerebelares 11 . Na paciente APS, de nossa casuística, o tumor achava-se localizado na linha média do cerebelo e no caso da paciente TRC, no hemisfério cerebelar direito, invadindo, porém, a linha média.…”

Section: Discussionunclassified

“…Segundo a literatura compulsada, o momento da instalação do mutismo é variável, podendo ser observado logo após o despertar da anestesia 2,12,24,35,36,37 até horas ou dias depois da operação 1,5,8,12,13 , enquanto sua duração oscila de dias a meses 8,12,13,23,24 , desaparecendo, na maior parte dos casos, entre 4 dias e 4 meses após seu surgimento 8,12 . O mutismo pode ser precedido por fase de disartria 8 , sendo que, mais comumente, esta surge após seu desaparecimento 2,9,l1,36 , o que lhe confere caráter orgânico e não psíquico.…”

Section: Discussionunclassified

“…Sua lesão bilateral é essencial para a ocorrência do mutismo, pois o comprometimento de apenas um dos hemisférios cerebelares não o ocasiona. Os casos de mutismo relatados por Çakir e col. 23 e por Longman e Tenuto 27 , e como ocorreu também na paciente TRC de nossa casuística, embora se tratasse de tumores situados em apenas um dos hemisférios cerebelares, deveriam ter sofrido compressão ou invasão do hemisfério contralateral.…”

Section: Discussionunclassified

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Mutismo cerebelar transitório: relato de dois casos

Silva

Atayde

Brito

et al. 1999

Arq. Neuro-Psiquiatr.

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RESUMO -Relatamos dois casos de mutismo observados após ressecção de tumores do cerebelo em duas crianças do sexo feminino, tratando-se, no primeiro caso de meduloblastoma, e no segundo, de astrocitoma juvenil. Em ambas havia lesão pré-operatória de nervos bulbares. A fisiopatogenia do mutismo envolve fatores anatômicos, vasculares e emocionais. As características essenciais do mutismo cerebelar são discutidas com base em revisão da literatura.PALAVRAS-CHAVE: mutismo, afasia, tumores do cerebelo. Transitory cerebellar mutism: report of two casesABSTRACT -We present two cases of mutism observed after resection of tumors of the cerebellum, in two children of the feminine sex, being in the first case of medulloblastoma and in the second of juvenile astrocytoma. In both patients there was pre-operative lesion of low cranial nerves. The pathophysiology of the mutism involves anatomical, vascular and emotional factors, being its essential characteristics discussed with base in revision of the literature.KEY WORDS: cerebellar mutism, aphasia, cerebellar tumor.Mutismo foi definido por Crutchfield e col. 1 como uma situação na qual o paciente está consciente, mas incapaz de falar, enquanto Nagatani e col. 2 definiram-no como uma forma extrema de disartria ou anartria.Disartria provocada por disfunções cerebelares é fenômeno bastante conhecido. Charcot, em 1877 (apud Lechtenberg e Gilman 3 ) foi o primeiro autor a imputar distúrbios cerebelares como causa de disartria. Ainda segundo estes autores, Mills e Weisenburg, em 1914, introduziram a noção de que a disartria resultaria da lesão do verme cerebelar superior. Em casuística de 122 pacientes com lesões cerebelares, Lechtenberg e Gilman 3 encontraram 31 com distúrbios disártricos, mais observados em lesões acometendo a porção superior do hemisfério cerebelar esquerdo.Benson (apud Nagatani e col. 2 ), em 1979, descreveu as situações em que ocorre mutismo: lesão da área de Broca, lesão da área motora suplementar do hemisfério cerebral dominante, lesão da formação reticular mesencefálica, lesão difusa dos hemisférios cerebrais, causando paralisia pseudobulbar e talamotomia bilateral empregada no tratamento da doença de Parkinson.

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Section: Discussionunclassified

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Mutismo cerebelar transitório: relato de dois casos

Silva

Atayde

Brito

et al. 1999

Arq. Neuro-Psiquiatr.

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“…Mutizm için latent periyodun operasyon sonrası ortalama 1.7 gün (1-7 gün), toplam sürenin ise 69.2 gün (6-365 gün) olduğu ve tüm vakalarda mutizmin geri döndüğü belirtilmiştir. PFS'nin bir parçası olan serebellar mutizm çoğunlukla çocuklarda görülmekle birlikte birkaç erişkin vaka da bildirilmiştir 10,11 . Çoğu hastada operasyondan sonra 1-2 gün içinde mutizm gelişmekte ve düzelme haftalar veya aylar sonra olmaktadır.…”

Section: Introductionunclassified

Posterior Fossa Syndrome

Küpeli¹

SpringerReference

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Posterior fossa syndrome is defined as the temporary and complete loss of speech after posterior fossa surgery which is not related to cerebellar hemorrhage, infection of the cerebellum, degenerative or neoplastic diseases of the cerebellum. In this review, we aimed to outline the incidence of posterior fossa syndrome, to define the risk factors for posterior fossa syndrome, to describe accompanying neurobehavioural and psychologic problems and to speculate about the etiologic mechanisms. The diagnosis of medulloblastoma and midline location of the tumor are important risk factors for the development of posterior fossa syndrome. These findings support the hypothesis that temporary ischemia and edema due to retracted and largely manipulated dentate nuclei and superior cerebellar pedincles may be the cause of mutism. Informing the family and the patient about the posterior fossa syndromemust be a component of the preoperative interview and patients who developed posterior fossa syndrome should be followed for accompanying neurobehavioural and psychologic problems even after mutism improved.

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Transient mutism following posterior fossa surgery studied by single photon emission computed tomography (SPECT)

Clerico

Sordi

et al. 2002

Med. Pediatr. Oncol.

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Cerebellar mutism is a transient and not uncommon complication, following surgical resection of a tumor located in the posterior fossa. Children who develop this kind of mutism are conscious with good comprehension and no evidence of oral apraxia. It was described, for the first time, in children with cancer by Rekate et al. in 1985 [1].We have found a total of 87 cases in the English literature since 1985 [2-10], along with reports on two adults who were affected with cerebellar neoplasia [11,12].In our clinic, two of the medulloblastoma patients developed postoperative cerebellar mutism. The first was a 14-year-old girl; the second, an 8-year-old boy, was of particular interest because single photon emission tomography (SPECT) analysis in his case detected focal anatomic changes.He presented with headache and vomiting, visual disturbances, and nystagmus of 4 months' duration and magnetic resonance imaging (MRI) showed a tumor in the cerebellar vermis (floor of the fourth ventricle), extending down to the level of the first cervical vertebra. Obstructive hydrocephalus was also present.The neurosurgeon considered total resection impossible and two courses of preoperative chemotherapy (carboplatin 1,000 mg/m 2 etoposide 300 mg/m 2 , 21-28 days apart) were then administered. MRI performed 2 weeks after the second course showed tumor shrinkage of more than 50% and complete removal was then possible. Histology revealed a medulloblastoma. Four hours after surgery, the child spoke fluently, but 48 hr later developed mutism, and behavioral disturbances: refusal to eat, reaction of anger against the mother, decreased initiation of voluntary movements, and urinary incontinence with no obvious urologic or neurologic disorder. SPECT images revealed hypoperfusion in the left frontal and occipital zone and the right occipito-parietal zone (Figs. 1A and 2A,C).Neuro-psychological testing during the recovery period demonstrated poor initiation and completion of age appropriate motor and problem solving activities, despite improvement in overall mood.After a period of 90 days, the boy started to speak using single words, his speech rate was very slow, the words were spelled sound by sound with a strainedstrangled voice. The improvement was confirmed by SPECT images performed 6 months after the first. They revealed normal perfusion in the left frontal and right parieto-occipital regions and a reduction in the hypoperfusion in the left occipital region (Figs. 1B and 2B,D).Today, 20 months after neurosurgery, the child has not yet completely recovered fluent speech, and ataxia still persists. DISCUSSIONReversible alterations in regional cerebral blood flow (rCBF) can easily be detected by technetium-99m ethyl-cysteinate dimer (ECD) SPECT. Tc-ECD is a relatively small tracer (< 500 D), lipophylic, with a net charge of zero. It is able to cross the blood-brain barrier and is well distributed in the brain, but the radionuclide rapidly leaves the brain tissue. Ethyl-cysteinate dimer is a ligand that combines the features of high brain u...

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Cerebellar mutism in an adult: Case report

Cited by 36 publications

References 5 publications

Mutismo cerebelar transitório: relato de dois casos

Mutismo cerebelar transitório: relato de dois casos

Posterior Fossa Syndrome

Transient mutism following posterior fossa surgery studied by single photon emission computed tomography (SPECT)

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