The Understanding of Pediatric Akinetic Mutism.

Luiz Severo Bem,Júlia L Gemir,Renata R M Cysneiros,Hildo C Azevedo

doi:10.7759/cureus.12593

Abstract

Pediatric akinetic mutism syndrome is a clinical disease resulting from cerebellar injury and characterized by the absence of speech or reduced speech, emotional lability, there may also be hypotonia, oropharyngeal dysfunction/dysphagia, bladder and intestinal incontinence, or other behavioral disorders and neurological signals. It is described as the most recurrent complication in children, after posterior fossa tumor surgery, mainly related to cerebellar midline injuries. An increasing number of research and prospective reviews have provided valuable information on cerebellar mutism syndrome in recent years. The purpose of this review was to elucidate the pathophysiological basis and the predictive factors for this syndrome. Most cases of mutism are due to injury cerebellar tracts and cerebellar-cerebral circuits, involving particularly distinct points of the dentate-thalamus-cortical and dentato-rubro-thalamus-cortical. Advanced neuroimaging techniques, such as tractography and perfusion studies, have contributed to demonstrating changes in these pathways in patients with pediatric cerebellar mutism.

Highlights

BackgroundAccording to the new studies, the current characteristics of mutism can be defined as delayed onset mutism/reduced speech and emotional lability
Posterior fossa surgical access is one of the most prevalent in children. This access is related to akinetic mutism (AM)
We considered that akinesia and mutism originated from the lesion of the basal ganglia, while hypothalamic injury caused disturbances in the accommodation of body temperature, blood pressure, and heart rate

Summary

Introduction

According to the new studies, the current characteristics of mutism can be defined as delayed onset mutism/reduced speech and emotional lability. Posterior fossa surgical access is one of the most prevalent in children This access is related to akinetic mutism (AM). Mutism cases are related in the age range from two to ten years. It is known as the most common histological type of tumor of the posterior fossa is medulloblastoma [3,4]. Given a close relationship with posterior fossa surgery, it is more likely to involve initial parts (e.g., dentate nucleus or superior cerebellar peduncle). Cerebellar mutism (CM) usually develops more in children than adults, after posterior fossa surgery. This condition does not usually appear immediately after surgery but after hours or days.

Conclusions

Disclosures