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Complete mutism after midbrain periaqueductal gray lesion.

A Esposito¹, G Demeurisse, B Alberti

¹Service de Revalidation Neurologique, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.

|April 20, 1999

Summary

The midbrain periaqueductal gray (PAG) is crucial for vocalization. A patient with a PAG lesion experienced irreversible mutism, preserving language and non-verbal skills, highlighting the PAG's role in human vocal control.

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Area of Science:

Neuroscience
Neurophysiology
Clinical Neurology

Background:

The midbrain periaqueductal gray (PAG) is implicated in vocalization initiation across species.
Human cases of mutism linked to PAG lesions are exceptionally rare.

Observation:

A patient (GM) developed complete and irreversible mutism after an ischemic lesion to the midbrain periaqueductal gray.
Despite mutism, the patient retained intact language comprehension and non-verbal expressive capacities.

Findings:

The periaqueductal gray (PAG) in humans serves as a critical nexus.
It integrates external and internal stimuli from sensory and emotional centers for vocalization.
The PAG connects these stimuli to the brainstem's vocal-motor coordination mechanisms.

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Implications:

This case reinforces the PAG's essential role in human vocalization control.
It suggests the PAG is vital for translating sensory and emotional information into vocal output.
Understanding PAG function is key for treating speech and vocal disorders.