Callosal mutism after AVM embolization in territoy of distal anterior cerebral artery branches

Abstract

Introduction: Callosum mutism (CM) is a rare complication of neurosurgical procedures. There is no previous report of its ocurrence after interventional endovascular procedures for intracranial lesions. Material and method: We present a case of CM after embolization of anterior cerebral artery branches for treatment of a left frontal arterio-venous malformation (AVM). After reporting the particularities of clinical and radiological presentation of such case, we preform a critical literature review and discusses the clinical and ethiological aspects of CM as well as its differences in relation to other genders of speech disturbances (like aphasias). Finally we provide a brief overview about present available methods of cortical function monitoring emphasizing their utility in therapeutic endovascular procedures in eloquent areas. Result and conclusion: In literature, there are no previous report of CM as a complication of therapeutic angiographic procedures. Its exact pathophysiology is unknown. It is usually believed that this syndrome may appear after lesion of any of the components of the dentate-thalamic-cortical pathway, as well as supplementary motor area and mesolimbic regions involved in speech production. The diagnosis of CM must be considered after a clinical picture of speech deficit after therapeutic endovascualr procedures in territory of distal branches of anterior cerebral artery, specially of frontopolar (FpA branch) and anterior internal frontal (AIFA) branches.