Cause and outcome of cerebellar mutism: evidence from a systematic review

Reed-Berendt, Rosa; Phillips, Bob; Picton, Susan; Chumas, Paul; Warren, Daniel; Livingston, John H.; Hughes, Ellen; Morrall, Matthew C.H.J.

doi:10.1007/s00381-014-2356-0

Cited by 56 publications

(36 citation statements)

References 85 publications

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“…This rare but devastating syndrome may occur in children after surgery for a cerebellar tumour and causes an inability to speak in addition to emotional lability and behavioural disturbances (Küper and Timmann 2013; Reed-Berendt et al 2014). The syndrome may occur even in a telovelar approach when there seems to be no damage to the cerebellar cortex or white matter.…”

Section: Introductionmentioning

confidence: 99%

Dentatorubrothalamic tract localization with postmortem MR diffusion tractography compared to histological 3D reconstruction

et al. 2015

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Diffusion-weighted imaging (DWI) tractography is a technique with great potential to characterize the in vivo anatomical position and integrity of white matter tracts. Tractography, however, remains an estimation of white matter tracts, and false-positive and false-negative rates are not available. The goal of the present study was to compare postmortem tractography of the dentatorubrothalamic tract (DRTT) by its 3D histological reconstruction, to estimate the reliability of the tractography algorithm in this specific tract. Recent studies have shown that the cerebellum is involved in cognitive, language and emotional functions besides its role in motor control. However, the exact working mechanism of the cerebellum is still to be elucidated. As the DRTT is the main output tract it is of special interest for the neuroscience and clinical community. A postmortem human brain specimen was scanned on a 7T MRI scanner using a diffusion-weighted steady-state free precession sequence. Tractography was performed with PROBTRACKX. The specimen was subsequently serially sectioned and stained for myelin using a modified Heidenhain–Woelke staining. Image registration permitted the 3D reconstruction of the histological sections and comparison with MRI. The spatial concordance between the two modalities was evaluated using ROC analysis and a similarity index (SI). ROC curves showed a high sensitivity and specificity in general. Highest measures were observed in the superior cerebellar peduncle with an SI of 0.72. Less overlap was found in the decussation of the DRTT at the level of the mesencephalon. The study demonstrates high spatial accuracy of postmortem probabilistic tractography of the DRTT when compared to a 3D histological reconstruction. This gives hopeful prospect for studying structure–function correlations in patients with cerebellar disorders using tractography of the DRTT.Electronic supplementary materialThe online version of this article (doi:10.1007/s00429-015-1115-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Dentatorubrothalamic tract localization with postmortem MR diffusion tractography compared to histological 3D reconstruction

et al. 2015

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“…It has been reported [19] that the floor of the 4th ventricle is associated with postoperative cerebellar mutism. Some tumors located in the 4th ventricle are large enough to make an obvious compression of the dentato-thalamo-cortical pathway, which is hypothesized as the “language center” [20, 21], which makes the center at risk of damage, meaning even a little irritation from the surgery may cause severe complications. In our study, we used the rostrocaudal and ventrodorsal length of tumor to predict the postoperative outcome, and we found significant differences in postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognostic Factors of Treatment in Pediatric Posterior Cranial Fossa Ependymoma

Agazzi

et al. 2019

Pediatr Neurosurg

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Objective: The purpose of this study was to explore the clinical features and risk factors of outcomes in pediatric posterior cranial fossa ependymoma. We aim to provide evidence-based recommendations for the improvement of prognoses. Patients and Methods: The clinical data, treatment modalities, approaches performed, recurrence rates and times, as well as the outcomes of 94 cases were analyzed retrospectively. The characters of neuroimaging were further studied. Results: In data from the most recent follow-up, 27 cases had tumor recurrence. The time for tumor recurrence was 13.7 ± 7.7 months. The estimated overall survival and progression-free survival, based on Kaplan-Meier analysis, was 42.2 ± 2.9 months and 38.7 ± 3.4 months, respectively. Univariate analysis showed that being free of recurrence is closely related to the high tumor sphericity (p = 0.018), homogeneity of tumor texture (p = 0.001), and gross total resection (GTR; p < 0.001). Mortality is linked to low sphericity (p = 0.017) and brain stem edema (p = 0.005). Cerebellar mutism is correlated with posterosuperior compression of the 4th ventricle roof by the tumor. The incidence rate of cerebellar ataxia, cerebellar mutism, and cerebellar dysarthria is related to the rostral extension of the tumor within the 4th ventricle. The recurrence rate is higher in subtotal resection (STR) than in GTR, and the difference is significant (p < 0.001). Although there is no significant difference between the recurrence rates in the three types, an earlier recurrence is prone with tumors located in the paramidline-lateral compared to the midline (p = 0.021) and paramidline-medial areas (p = 0.042). Conclusions: Based on our data, GTR is indicated as the most optimal choice. Recurrence is linked to lower tumor sphericity, inhomogeneous tumor texture, and STR/partial resection. Tumor located on the lateral side might be prone for an early recurrence.

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“…It can be caused by diffuse cerebral cortical dysfunction, left hemispheric dysfunction (eg, owing to occlusion of the internal carotid artery), damage to Broca's area resulting in an expressive aphasia, damage to the mesencephalic reticular formation resulting in akinetic mutism, damage to the cerebellum (most often attributable to neurosurgical removal of the cerebellar vermis, and termed "cerebellar mutism"), 2 injury to the muscles and nerves that control speech, and bilateral vocal cord paralysis. In the context of altered mental status, difficulty swallowing, and weakness, I am concerned about dysfunction at the level of the brainstem.…”

Section: Dr Lautzmentioning

confidence: 99%

A 33-Month-Old With Fever and Altered Mental Status

Lautz¹,

Jenssen

McGuire³

et al. 2015

Pediatrics

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A 33-month-old girl presented with 3 days of fever and 1 day of multiple paroxysmal episodes of screaming with apparent unresponsiveness, flexed lower extremities, clenched hands, and upward eye deviation. These events lasted seconds to a minute at a time and occurred only during sleep. She slept peacefully between episodes and was easily awakened. She had a history of mild speech delay and mild intermittent asthma but was otherwise healthy. She was tired-appearing and fussy on examination with dry mucous membranes, but her examination was otherwise normal. A complete blood count with differential and serum levels of sodium, potassium, chloride, and calcium were normal, but her bicarbonate level was 12 mmol/L. Her fingerstick glucose level was 69 mg/dL. Urine dipstick was notable for large ketones, and a urine drug screen was normal. Cerebrospinal fluid examination yielded 2 white blood cells and 1040 red blood cells/mm 3 with normal chemistries. A computed tomography (CT) scan of her head was unremarkable, and an abdominal ultrasound demonstrated no evidence of intussusception. Over the course of her hospitalization, these paroxysmal episodes persisted, and she subsequently developed mutism, right-sided weakness, and difficulty swallowing liquids. Here we present her case, diagnostic evaluation, and ultimate diagnosis.

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Cause and outcome of cerebellar mutism: evidence from a systematic review

Cited by 56 publications

References 85 publications

Dentatorubrothalamic tract localization with postmortem MR diffusion tractography compared to histological 3D reconstruction

Dentatorubrothalamic tract localization with postmortem MR diffusion tractography compared to histological 3D reconstruction

Clinical Characteristics and Prognostic Factors of Treatment in Pediatric Posterior Cranial Fossa Ependymoma

A 33-Month-Old With Fever and Altered Mental Status

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