Mutism after removal of a vermian medulloblastoma: Cerebellar mutism

Nagatani, Kazuhiko; Waga, Shiro; Nakagawa, Yutaka

doi:10.1016/0090-3019(91)90094-p

Cited by 71 publications

(30 citation statements)

References 6 publications

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“…This finding has been reported in several studies, either after resection of posterior fossa tumors [1][2][3][4][5][6][7][8][9][10], with arteriovenous malformation (AVM) [8,9], or with trauma [11]. It has been difficult to estimate the incidence of cerebellar mutism, and few studies have attempted to do so.…”

Section: Introductionmentioning

confidence: 74%

“…It is also distinguished from oropraxia, in which performance of learned motor skills of face, lip, and tongue are affected without an apparent neuroanatomic lesion [12]. Cerebellar mutism is a severe dysarthria or anarthria in which there is profound impairment of fluency, articulation, and modulation of speech [8,12]. Cranial nerve function is uniformly intact in patients with cerebellar mutism [8].…”

Section: Discussionmentioning

confidence: 99%

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

Koh

Turkel

Baram

1997

Pediatric Neurology

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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.

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Section: Introductionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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

Koh

Turkel

Baram

1997

Pediatric Neurology

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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

“…A maioria dos casos de mutismo é observada em crianças após ressecção de tumores cerebelares medianos 1,2,4,[8][9][10]12,13,16,24,25 . 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 .…”

Section: Discussionunclassified

“…Ferrante e col. (apud Nagatami e col. 2 ) sugeriram dois mecanismos para o desencadeamento do mutismo: o psíquico, caracterizado por modificações do comportamento oral, com rejeição de alimentos, e o espasmo pós-operatório das artérias nutrientes do cerebelo e tronco cerebral, causando isquemia. A paciente TRC de nossa casuística apresentava inapetência acentuada, o que provocou nítida diminuição de seu peso.…”

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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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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Mutism after removal of a vermian medulloblastoma: Cerebellar mutism

Cited by 71 publications

References 6 publications

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

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

Mutismo cerebelar transitório: relato de dois casos

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

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