Cerebellar mutism in acute disseminating encephalomyelitis

Area of Science:

• Pediatric Neurology
• Neuroimmunology
• Neuroradiology

Background:

• Cerebellar mutism is a known complication following posterior fossa tumor resection in children.
• Cerebellar mutism associated with acute disseminated encephalomyelitis (ADEM) is exceptionally rare.
• ADEM typically presents as a post-infectious or post-vaccination demyelinating process.

Observation:

• A 7-year-old boy presented with acute onset fever, vomiting, diarrhea, altered mental status, and expressive aphasia.
• Neuroimaging revealed new diffusion restriction in the bilateral dentate nuclei and right cerebellum.
• The patient experienced initial improvement in verbalization with treatment.

Findings:

• The case demonstrates a rare presentation of cerebellar mutism secondary to ADEM.
• Cerebellar involvement in ADEM can result in significant expressive aphasia and cognitive impairment.
• Long-term language and cognitive difficulties were observed despite initial treatment response.

Implications:

• ADEM, though often benign, can precipitate severe and persistent neurological deficits affecting the cerebellum.
• This case underscores the importance of considering ADEM in the differential diagnosis of pediatric cerebellar mutism.
• Early recognition and management of ADEM are crucial to mitigate potential long-term neurodevelopmental consequences.