Abstract:
Cerebellar mutism syndrome (CMS) is a frequent complication of surgical intervention on posterior fossa in children. It has been only occasionally reported in adults and its features have not been fully characterized. In children and in young adults, medulloblastoma is the main reason for neurosurgery. A single case of postsurgical CMS is presented in an adult patient with a cerebellar hemorrhage and a systematic review of the published individual cases of CMS in adults was done. Literature review of individual cases found 30 patients, 18/30 (60%) males, from 20 to 71 years at diagnosis. All but one case was post-surgical, but in one of the post-surgical cases iatrogenic basilar artery occlusion was proposed as cause for CMS. The causes were: primary tumors of the posterior fossa in 16/22 (72.7%) metastasis in 3/30 (10%), ischemia in 3/30 (10%) cerebellar hemorrhage in 3/30 (10%), and benign lesions in 2/30 (6.7%) patients. 8/30 patients (26.7%) were reported as having persistent or incomplete resolution of CMS within 12 months. CMS is a rare occurrence in adults and spontaneous cerebellar hemorrhage has been reported in 3/30 (10%) adult patients. The generally accepted hypothesis is that CMS results from bilateral damage to the dentate nucleus or the dentate-rubro-thalamic tract, leading to cerebro-cerebellar diaschisis. Several causes might contribute in adults. The prognosis of CMS is slightly worse in adults than in children, but two thirds of cases show a complete resolution within 6 months.
摘要:
小脑mutism综合征(CMS)是儿童后颅窝手术干预的常见并发症。它仅偶尔在成人中报道,其特征尚未得到充分表征。在儿童和年轻人中,髓母细胞瘤是神经外科的主要原因。在一名患有小脑出血的成年患者中出现了一例术后CMS,并对已发表的成人CMS个例进行了系统回顾。文献复习个别病例发现30例患者,18/30(60%)男性,从20到71年的诊断。除了一个病例是术后,但在其中一例手术后病例中,医源性基底动脉闭塞被认为是CMS的病因。病因为:原发灶后颅窝16/22(72.7%)3/30(10%)转移,缺血3/30(10%)小脑出血3/30(10%),2/30(6.7%)患者出现良性病变。8/30患者(26.7%)被报告为在12个月内CMS持续或不完全消退。CMS在成人中很少发生,并且在3/30(10%)的成人患者中报道了自发性小脑出血。普遍接受的假设是,CMS是由于对齿状核或齿状红斑丘脑束的双侧损伤所致。导致大脑-小脑渗血。有几个原因可能会导致成年人。成人CMS的预后比儿童稍差,但三分之二的病例在6个月内显示完全解决。