Document Detail

The pathophysiologic mechanism of cerebellar mutism.
MedLine Citation:
PMID:  16793430     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Cerebellar mutism (CM) is a postoperative complication of mainly pediatric posterior fossa surgery. Multiple theories exist for explaining this phenomenon. We have made an attempt to further understand this entity given a particularly interesting case as it relates to multiple pathophysiologic pathways. METHODS: We have reviewed the details surrounding a particularly interesting case of CM. A retrospective analysis of this patient's clinical history and recovery is described. An extensive literature review has been performed in conjunction with an attempt to help elucidate details and a better understanding of CM. RESULTS: A thorough analysis of existing theories as to the pathophysiologic mechanism of CM has been performed as it relates to the details of this particular case. A case is described in which a child exhibiting CM abruptly improved and made a relatively quick recovery after the triggering of the melodic speech pathway by way of watching and beginning to sing along with a video. It appears that this incident involving a familiar song catalyzed various speech pathways, which apparently were in some state of shock. This phenomenon seems to be a temporary entity involving not only the mechanical coordination of speech production, but also the initiation of speech itself. CONCLUSIONS: Evidence exists for a pathophysiologic pathway for speech by way of coordinating phonation and articulation. In addition, there seems to exist a pathway by which the initiation of speech may be altered or halted by posterior fossa pathology, namely, vermian or dentate nuclear injury. In particular to this case, we found that the incidental appreciation of other forms of speech, melodic in this instance, may be the key to help stimulate and accelerate the recovery from CM.
Burak M Ozgur; John Berberian; Henry E Aryan; Hal S Meltzer; Michael L Levy
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Surgical neurology     Volume:  66     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-23     Completed Date:  2006-08-18     Revised Date:  2007-08-21    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-25     Citation Subset:  IM    
Pediatric Neurosurgery, Children's Hospital of San Diego, San Diego, CA 92123, USA.
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MeSH Terms
Acoustic Stimulation / methods
Cerebellar Diseases / etiology,  physiopathology*,  rehabilitation
Cerebellar Neoplasms / complications,  physiopathology*,  surgery
Child, Preschool
Hydrocephalus / complications,  physiopathology,  surgery
Medulloblastoma / complications,  physiopathology*,  surgery
Music Therapy
Mutism / etiology,  physiopathology*,  rehabilitation
Neural Pathways / physiopathology
Neurosurgical Procedures / adverse effects
Recovery of Function
Comment In:
Surg Neurol. 2007 Jul;68(1):117; author reply 118   [PMID:  17586248 ]

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