Transient cerebellar mutism after posterior cranial fossa surgery in an adult

Salvati, Maurizio; Missori, Paolo; Lunardi, Pierpaolo; Orlando, E

doi:10.1016/0303-8467(91)90096-8

Cited by 62 publications

(33 citation statements)

References 8 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: 75%

“…Patients with cerebellar mutism have lesions in the paramedian cerebellar vermis or floor of the fourth ventricle [1][2][3][4][5][6][7][8][9]11]. Cerebellar mutism apparently may be produced by insult to the cerebellar midline.…”

Section: Discussionmentioning

confidence: 99%

“…This may explain the development of mutism in patients with posterior fossa lesions. Hydrocephalus may be an exacerbating factor [9]. There is increasing interest in the potential role of the cerebellum in processing of learning and memory [14,15].…”

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: 75%

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 which is a component of the posterior fossa syndrome, occurs mostly in children, although a few adult cases have been published [18, 19]. In children, the tumor is typically described as large, located in the midline with brainstem and fourth ventricular involvement and hydrocephalus [4, 5, 20, 21].…”

Section: Discussionmentioning

confidence: 99%

Posterior Fossa Syndrome: Identifiable Risk Factors and Irreversible Complications

et al. 1999

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Cerebellar mutism was first described by Rekate et al. in 1985 as a transient condition which occurs after posterior fossa operations in children. Posterior fossa syndrome (PFS) and cerebellar mutism are often used interchangeably in the literature. In our experience, we found cerebellar mutism to be a reversible component of a persistent neurologic syndrome. The cause and identifiable risk factors have not been clearly elucidated in the literature. To further characterize PFS, we reviewed 253 children with posterior fossa tumors who underwent surgical resection. We documented 20 cases of PFS (8%), 12 males and 8 females. Age ranged from 1.5 to 13 years (mean = 6.5). Of the 20, 16 were medulloblastoma, 3 ependymoma and 1 astrocytoma. There was a 21% incidence (16/76) of PFS in medulloblastoma of the posterior fossa. The incidence for ependymoma was 13% (3/24) and 1% (1/102) for astrocytoma. All 20 cases (100%) had brainstem involvement by the tumor. The most frequent postoperative findings included mutism, ataxia, 6th and 7th nerve palsies and hemiparesis. Mutism had a latency range of 1–7 days (mean = 1.7) and a duration of 6–365 days (mean = 69.2, median = 35). Although mutism resolved in all cases, the remaining neurologic complications which characterized our findings of PFS were rarely reversible. We describe potential risk factors for developing PFS after surgery with hopes of making neurosurgeons more aware of potential problems following the removal of lesions in this area. Early recognition of PFS would further promote patient and family understanding and coping with this syndrome.

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“…This syndrome, as described after cerebellar surgery, is characterized by: (1) onset of the disorder usually after an interval varying from a few hours to 2–3 days; (2) temporariness varying from 3 to a maximum of 16 weeks; (3) gradual recovery of oral expression: first phonemes, then single words and finally complete phrases, with scanning speech (cerebellar dysarthria). All the cases reported in the literature regard children, with the exception of one young adult [5]. …”

Section: Discussionmentioning

confidence: 99%

Transient Muteness Followed by Dysarthria in Patients with Pontomesencephalic Stroke

Orefice¹,

Fragassi²,

Lanzillo³

et al. 1999

Cerebrovasc Dis

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Dysarthria is the principal motor abnormality following vascular damage to pontine paramedian structures, owing to the involvement of corticobulbar fibres. Here we describe 2 cases of adults affected by dysarthria following transient muteness as the result of a stroke in pontomesencephalic structures. Their clinical outcome was very similar to that of young patients who have undergone surgery of the 4th ventricle. Recently the importance of pons involvement has also been underlined in these cases. This case report suggests the existence of a functional network for speech, in which the pontomesencephalon is an important station for the triggering and the efficacy of verbal production.

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Transient cerebellar mutism after posterior cranial fossa surgery in an adult

Cited by 62 publications

References 8 publications

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

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

Posterior Fossa Syndrome: Identifiable Risk Factors and Irreversible Complications

Transient Muteness Followed by Dysarthria in Patients with Pontomesencephalic Stroke

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