Ann Rehabil Med.  2017 Dec;41(6):1076-1081. 10.5535/arm.2017.41.6.1076.

Neuroanatomical Mechanism of Cerebellar Mutism After Stroke

• Lee S
• Na YH
• Moon HI
• Tae WS
• Pyun SB

• KMID: 2400293
• DOI: http://doi.org/10.5535/arm.2017.41.6.1076

Abstract

Cerebellar mutism (CM) is a rare neurological condition characterized by lack of speech due to cerebellar lesions. CM is often reported in children. We describe a rare case of CM after spontaneous cerebellar hemorrhage. The patient showed mutism, irritability, decreased spontaneous movements and oropharyngeal apraxia. Diffusion tensor imaging revealed significant volume reduction of medial frontal projection fibers from the corpus callosum. In Tracts Constrained by UnderLying Anatomy (TRACULA) analysis, forceps major and minor and bilateral cingulum-angular bundles were not visualized. Cerebello-frontal pathway reconstructed from the FMRIB Software Library showed continuity of fibers, with decreased number of fibers on qualitative analysis. These results suggest that cerebello-frontal disconnection may be a neuroanatomical mechanism of CM. Damage of brain network between occipital lobe, cingulate and cerebellum caused by hemorrhage may also have role in the mechanism of CM in our case.

Keyword

Akinetic mutism; Cerebellum; Diffusion tensor imaging

MeSH Terms

Akinetic Mutism
Apraxias
Brain
Cerebellum
Child
Corpus Callosum
Diffusion Tensor Imaging
Hemorrhage
Humans
Mutism*
Occipital Lobe
Stroke*
Surgical Instruments

Figure

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  Fig. 1 Computed tomography scan showing a large amount of cerebellar hemorrhage (A) and tangled vascular structure (arrowhead) (B).

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  Fig. 2 Corticospinal tract (A), arcuate fasciculus (B), axial view (C) and sagittal view (D) of the corpus callosum with significant fiber loss projecting on medial frontal cortex (arrow).

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  Fig. 3 All tracts reconstructed by TRACULA (Tracts Constrained by UnderLying Anatomy). Forceps major, forceps minor (arrowhead) (A-a), and bilateral cingulum-angular bundles (arrow) (A-b) of a healthy control were not visualized in our case (B-a, B-b).

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  Fig. 4 Fronto-cerebellar pathway reconstructed by the FMRIB Software Library (FSL). (A) At the cerebellar hemorrhage level. (B) Decreased fronto-cerebellar fibers (arrows) between the right cerebellum and left frontal cortex was seen at the caudal midbrain level of cerebellar decussation and (C) prefrontal area.

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  Fig. 5 Results of cognitive evaluation at 15 months after stroke. Attention and executive function scores were decreased in our case. A-CPT, auditory continuous performance test; V-CPT, visual continuous performance test; Raven CPM, Raven Coloured Progressive Matrices.

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