Related Experiment Videos
Post-traumatic mutism in children: clinical characteristics, pattern of recovery and clinicopathological correlations
1Department of Paediatrics and Paediatric Surgery, CHUV, Lausanne, Switzerland.
Insights
Post-traumatic mutism in children, a rare condition after severe head injury, involves a temporary loss of speech. Research suggests mesencephalic structure involvement may cause this disorder.
Area of Science:
- Pediatric Neurology
- Neurotraumatology
- Clinical Psychology
Background:
- Post-traumatic mutism is a rare syndrome following severe traumatic head injury.
- It is infrequently reported in adults and poorly understood in children.
Purpose of the Study:
- To provide a detailed clinical characterization of post-traumatic mutism in children.
- To explore differential diagnoses, brain imaging correlations, and the potential neurological basis of this condition.
Main Methods:
- Case series of seven pediatric patients (3.5–14 years) with severe head injury and subsequent mutism.
- Clinical assessment of speech, non-verbal communication, and neurological signs.
- Review of brain imaging and relevant experimental animal data.
Main Results:
- Patients experienced prolonged coma (5–25 days) followed by mutism (5–94 days), with preserved non-verbal communication.
- Initial speech recovery included hypophonic, monotonous voice, dysarthria, and word-finding difficulties, but no aphasia or comprehension deficits.
- Neurological signs included oculomotor nerve (III) paresis and autonomic dysfunction, suggesting mesencephalic involvement.
Conclusions:
- Post-traumatic mutism in children presents with specific speech and neurological characteristics.
- Evidence points towards the involvement of mesencephalic structures in the etiology of post-traumatic mutism.
Abstract:
Among the numerous clinical syndromes observed after severe traumatic head injury, post-traumatic mutism is a disorder rarely reported in adults and not studied in any detail in children. We report seven children between the ages of 3 1/2 and 14 years who sustained severe head injury and developed post-traumatic mutism. We aim to give a precise clinical characterization of this disorder, discuss differential diagnosis and correlations with brain imaging and suggest its probable neurological substrate. After a coma lasting from 5 to 25 days, the seven patients who suffered from post-traumatic mutism went through a period of total absence of verbal production lasting from 5 to 94 days, associated with the recovery of non-verbal communication skills and emotional vocalization. During the first days after the recovery of speech, all patients were able to produce correct small sentences with a hypophonic and monotonous voice, moderate dysarthria, word finding difficulties but no signs of aphasia, and preserved oral comprehension. The neurological signs in the acute phase (III nerve paresis in three of seven patients, signs of autonomic dysfunctions in five of seven patients), the results of the brain imaging and the experimental animal data all suggest the involvement of mesencephalic structures as playing a key role in the aetiology of post-traumatic mutism.