Cerebellar mutism in children: Report of six cases and potential mechanisms

Abstract

Cerebellar mutism is a rare finding associated with resection of posterior fossa tumors or cerebellar hemorrhages. We reviewed the medical records of six children, aged 6 to 12 years, who developed cerebellar mutism after resection of a posterior fossa mass or as a result of posterior fossa trauma. From 1989 to 1994, 210 children underwent posterior fossa resection at our institution, and four developed mutism (an incidence of 1.6%). All four patients had primitive neuroectodermal tumors. The fifth patient experienced trauma, and another patient had an arteriovenous malformation (AVM). In four children, hydrocephalus developed as a result of their tumor or AVM. Four developed cerebellar mutism 24 to 48 hours after surgery or trauma, and one developed cerebellar mutism 5 days after surgery, coincident with hydrocephalus. In one, mutism occurred after a second resection was performed for a recurrence of his posterior fossa tumor. Cerebellar mutism lasted 10 days in one patient and 2 to 8 weeks in the other four. Dysarthria was apparent in four patients during the recovery phase. We suggest trauma to the dentate nucleus and/ or its outflow tract, the superior cerebellar peduncle, as a cause of reversible mutism. Because posterior fossa tumors are common in children, mutism should be recognized as an important side effect of surgery.

Posterior Fossa Syndrome after a Vermian Stroke: A New Case and Review of the Literature

“…Indeed, a review of the literature only reveals 9 cases of cerebellar mutism following posterior fossa lesions of vascular origin, including 2 adult cases [3, 4, 6,8,9,10, 41, 42] (table 2). In addition, 3 cases with so-called transient cerebellar mutism following vascular damage to cerebellar and/or adjacent structures of the cerebellum have been described.…”

“…For instance, Dietze and Mickle [4] did not report any behavioral abnormalities or signs of emotional distress, and Koh et al [6] stated that the mental and cognitive status of their patient was not significantly impaired. Turkel et al [9] investigated 19 children with posterior fossa lesions of which 2 cases had a vascular etiology, focusing on behavioral and emotional disturbances.…”

“…Although in the majority of cases the PFS resulted from posterior fossa tumor resection (n = 203, 90%), other etiological causes have been described as well. A review of the literature since 1972 shows that only 10 (4.4%) of the 225 pediatric cases had a vascular etiology [3,4,5,6,7,8,9,10,11], 5 subjects (2.2%) had traumatic lesions [6,12,13,14] and 7 cases (3.1%) developed cerebellar mutism following an infection [15,16,17,18,19,20]. …”

Cerebellar mutism

“…107 Ozimek et al 70 reported 4 cases of CM with bilateral extension of the tumor into the cerebellar hemispheres. There have also been cases of CM with isolated hemispheric lesions such as contusion 51 or metastasis. 85 Neurophysiological studies have shown that the left cerebellar hemisphere is important for the executive functions.…”

“…It usually appears as a consequence of posterior fossa surgery in children with cerebellar or fourth ventricle tumors. 52,82,108 Other causes that have been reported are infections, 15,19,24,26,72 posterior fossa hematomas (surgically removed 31,89 or not 60 ), arteriovenous malformations, 33,51,82 a brainstem tumor, 82 a pineal gland tumor, 23 and traumatic cerebellar injury. 15,82 Although this clinical entity is mainly seen in children, there are also reports of CM in adults.…”