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Cerebellar mutism caused by arteriovenous malformation of the vermis
A Al-Anazi1, M Hassounah, B Sheikh
1Department of Neurosurgery King Fahad Hospital of the University, Al-Khobar, Saudi Arabia. alanazil@hotmail.com
Abstract:
Transient mutism following posterior fossa tumour resection in children is well known in the literature. To our Knowledge, this phenomenon has never been reported without surgical intervention. We report a case of cerebellar mutism secondary haemorrhage from a vermian arteriovenous malformation (AVM), which resolved to ataxic dysarthria after 6 weeks. Embolization of the AVM was performed and the patient's clinical status continued to improve gradually till she became normal 6 months from the insult. The mutism was due to rupture of the AVM which might correlate the cerebellar mutism with the transient vasospasm of the blood vessels supplying the cerebellum. It is possible for a spontaneus posterior fossa bleed to result in transient mutism similar to post surgical mutism.
Insights
A rare case of cerebellar mutism occurred due to a cerebellar arteriovenous malformation (AVM) bleed, not surgery. This condition, typically seen after posterior fossa surgery, highlights spontaneous bleeds as a potential cause.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Neurology
Background:
- Transient mutism is a known complication following posterior fossa tumor resection in children.
- The exact pathophysiology of post-surgical mutism remains incompletely understood, but is often attributed to cerebellar injury.
Observation:
- This report details a unique case of cerebellar mutism in a child resulting from a hemorrhage of a vermian arteriovenous malformation (AVM).
- The patient presented with mutism, which gradually evolved into ataxic dysarthria over six weeks.
- The AVM was successfully treated with embolization.
Findings:
- The study suggests that spontaneous posterior fossa bleeds, such as from an AVM rupture, can induce transient mutism.
- Cerebellar mutism in this case is hypothesized to be related to transient vasospasm in cerebellar blood vessels secondary to the hemorrhage.
- This finding expands the known etiology of cerebellar mutism beyond surgical intervention.
Implications:
- This case broadens the differential diagnosis for cerebellar mutism in pediatric patients.
- It underscores the importance of considering vascular malformations and spontaneous hemorrhage as potential causes of mutism in the posterior fossa.
- Further research into the vascular and neurological mechanisms underlying cerebellar mutism is warranted.