1/17. Transient mutism resolving into cerebellar speech after brain stem infarction following a traumatic injury of the vertebral artery in a child.A 3.7-year-old girl presented with an anterior neck injury followed by progressive subcutaneous emphysema and loss of consciousness. After resuscitation, a laceration on the first tracheal cartilage was closed surgically. As she was extubated one week later, she was found to have right hemiplegia and muteness. MRI showed a T2-bright lesion on the tegmentum of the left midbrain down to the upper pons. Right vertebral angiography disclosed an intimal flap with stenosis at the C3 vertebral level presumably caused by a fracture of the right C3 transverse process later confirmed in a cervical 3D-CT scan. Her muteness lasted for 10 days, after which she began to utter some comprehensible words in a dysarthric fashion. Her neurological deficits showed improvement within 3 months of her admission. Transient mutism after brain stem infarction has not been reported previously. We discuss the anatomical bases for this unusual reversible disorder in the light of previous observations and conclude that bilateral damage to the dentatothalamocortical fibers at the decussation of the superior cerebellar peduncle may have been responsible for her transient mutism.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
2/17. Mutism after evacuation of acute subdural hematoma of the posterior fossa.CASE REPORT: A 7-year-old boy was involved in a road traffic accident. A computed tomography scan revealed an acute subdural hematoma (ASDH) of the posterior fossa, traumatic subarachnoid hemorrhage, and distortion of the brain stem. Removal of the ASDH was completed 3.5 h after injury. After extubation, the patient rapidly recovered consciousness. He was able to follow commands, although he did not speak. He began to utter 14 days after the injury. His speech became normal 39 days after injury. A magnetic resonance imaging scan revealed a post-contusional change in the right cerebellum and an ischemic lesion in the pons. DISCUSSION: Immediate removal of the hematoma is the only therapy for patients with ASDH of the posterior fossa. Although any lesions of the dentate nucleus, red nucleus, thalamus, cerebral cortex, and pons, all of which are involved in this case, are able to cause mutism, his mutism was primarily caused by the severe ASDH of the posterior fossa. The transient nature of this syndrome suggests that the cause of the mutism is trauma-related edema and/or transient ischemia of these structures.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
3/17. Cerebellar mutism in adults after posterior fossa surgery: a report of 2 cases.BACKGROUND: Mutism has been associated with injury to midline cerebellar structures secondary to degenerative disease, tumors, hemorrhage, or surgery. Typically, cerebellar mutism syndrome (CMS) has been seen in children and only rarely described in adults after surgery of the posterior fossa. This syndrome typically arises 48 hours after the initiating event and resolves approximately 7 to 8 weeks later. Characteristics of CMS include complete absence of speech without impaired consciousness, other cranial nerve deficits, or long tract signs. CASE DESCRIPTION: The authors report on 2 patients each of whom developed cerebellar mutism after tumor resection using a posterior fossa approach. The first patient underwent gross total resection of a pineal region tumor via a supracerebellar approach. The second patient underwent posterior fossa decompression for a left cerebellar hemispheric renal cell carcinoma metastasis with adjacent hemorrhage. One patient displayed a variant of cerebellar mutism with severe ataxic dysarthria without complete absence of speech, whereas the other demonstrated frank mutism. After neuroimaging studies confirmed the absence of a surgically treatable postoperative cause for the patients' symptoms, they were managed in a supportive fashion (eg, speech therapy) and improved within 3.5 months and 1 year, respectively. CONCLUSION: It is paramount that neurosurgeons be aware of cerebellar mutism with regard to its very rare occurrence in adults, its time of onset, and typical self-limiting course.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
4/17. Mutism after cerebellar medulloblastoma surgery.The case of a 9-year-old boy is presented, who developed transient mutism after removal of a medulloblastoma in the region of the cerebellar vermis. The mutism disappeared within 6 months. Neither reduction of consciousness nor disturbances of caudal cranial nerves or phonation ever appeared. The case is discussed with regard to its phenomenology, pathogenesis, and etiology, corresponding case reports are also taken into consideration.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
5/17. Transient cerebellar mutism after posterior cranial fossa surgery in an adult. Case report and review of the literature.Transient mutism, without disorders of consciousness or cranial nerve deficits, arising after surgical operations on the posterior cranial fossa is a recently described entity. To date 22 cases have been reported, to which we add the present case (the first report of the syndrome in an adult). We review the salient features of the syndrome in the light of the published cases and speculate on the underlying physiopathology.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
6/17. Mutism after removal of a vermian medulloblastoma: cerebellar mutism.A case of mutism after removal of a vermian medulloblastoma from a 4-year-old girl is reported. Postoperatively, the patient was mute without disturbance of consciousness, language comprehension, or lower cranial nerve function. Computed tomography scans demonstrated no abnormal findings except for the surgical lesion in the posterior fossa. The mutism lasted for 78 days, followed by a period of dysarthria, but she gradually became fluent. The mechanism of "cerebellar mutism" is briefly discussed.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
7/17. Mutism after posterior fossa surgery in children. Report of three cases.Three patients aged 5 1/2 to 9 years old with mutism after posterior fossa surgery are presented. The entity is discussed with a review of 15 additional previously reported cases in children aged 2 to 11 years. In all 18 patients, a large midline tumor of the posterior fossa (medulloblastoma in nine cases, astrocytoma in five, and ependymoma in four), often attached to one or both lateral recesses of the fourth ventricle, was removed. Mutism developed 18 to 72 hours after the operation (mean 41.5 hours) in patients with no disturbance of consciousness and no deficits of the lower cranial nerves or of the organs of phonation. All of these children had spoken in the first hours after surgery. The disorder lasted from 3 to 16 weeks (mean 7.9 weeks). Speech was regained after a period of dysarthria in six of the 10 cases for whom this information was available. The various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
8/17. Reversible leukoencephalopathy caused by 5-fluorouracil derivatives, presenting as akinetic mutism.Two cancer patients are reported, who presented with altered consciousness 2 and 3 months, respectively, after the administration of 5-fluorouracil derivatives, and progressed to a state of akinetic mutism. At first a presumptive diagnosis of metastatic brain tumor was made. However, the result of a cerebrospinal fluid cytology for malignancy was negative, and computed tomography (CT) scanning revealed diffuse decreased attenuation of the cerebral white matter, indicative of leukoencephalopathy, without association of mass lesion. Upon discontinuing the drugs, both patients made significant recovery and the decreased attenuation on the CT also disappeared. The significance of the early diagnosis of this pathology is emphasized.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
9/17. Six cases of cerebromedullospinal disconnection after cardiac arrest.Six cases of cerebromedullospinal disconnection after cardiac arrest are reported. The diagnosis was based on mutism, consciousness and/or wakefulness, and global paralysis, except for some very limited motor functions, mostly eye movements. consciousness was defined as repetitive contact with the patient by way of simple motor response. Despite of the fatal outcome in all cases, the importance of diagnosis and correct handling is stressed.- - - - - - - - - - ranking = 1keywords = consciousness (Clic here for more details about this article) |
10/17. Mutism after closed head injury.Prospective study of patients admitted to a hospital for closed head injury showed that nine patients (nearly 3%) became mute for varying periods despite recovery of consciousness and communication through a nonspeech channel. Computed tomography (CT) showed subcortical lesions situated primarily in the putamen and internal capsule of four patients, whereas four of the five patients without subcortical lesions had left-hemisphere cortical injury. The patients without subcortical injury visualized by CT exhibited a longer duration of impaired consciousness consistent with severe diffuse brain injury and they showed more long-term linguistic deficits. We related our findings to recent studies of atypical aphasia after occlusive vascular lesions of the basal ganglia.- - - - - - - - - - ranking = 2keywords = consciousness (Clic here for more details about this article) |
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