A case of cerebellar mutism initially diagnosed as adjustment disorder with anxiety

Abstract

Cerebellum, along with balance and motor function, also plays a role in higher cognitive processes and affect regulation. Left cerebellar hemisphere may be responsible for executive tasks while right cerebellar hemisphere may play roles in language perception, speech timing, motor planning, transient storage of verbal information, verbal fluency and processing grammar. “Cerebellar mutism” (CM) defines absence or severe reduction of speech along with irritability, emotional lability and social withdrawal . CM may develop in 11.0-29.0 % of children after surgeries involving the posterior fossa and is especially seen among patients with medulloblastomas and/ or brainstem lesions. However, cases developing after ischemic strokes involving the cerebellum have also been described. In CM patients who were operated on for tumors, typically, the speech is normal for a brief period after surgery and deteriorates thereafter. In the majority of patients, mutism resolves after weeks to months although it may persist longer in some. The exact pathophysiology of CM is unclear and features of the syndrome may be interpreted as psychological in origin. Here, we report diagnosis of CM in a three-years old toddler.