Cerebellar mutism after spontaneous intratumoral bleeding involving the upper cerebellar vermis: a contribution to the physiopathogenic interpretation

Transient mutism as a consequence of posterior fossa surgery is a well-known phenomenon. However, it has rarely been reported after focal nonsurgically induced cerebellar damage. We describe a 7-year-old child affected by a tumor arising from the quadrigeminal plate who developed transient cerebellar mutism after a spontaneous bleeding which extended to the upper cerebellar vermis. The recovery from mutism started about a week after the bleeding. At the time of the surgical treatment, 8 weeks after the spontaneous intratumoral bleeding, she was only dysarthric. To our knowledge, this is the first pediatric case of presurgical cerebellar mutism due to a hemorrhage of a neoplastic lesion. Moreover, the focality of bleeding allows the confirmation of the role played by the upper vermis in speech control as well as exclusion of surgically induced lesions commonly suggested as possible cause of the cerebellar mutism.