Ozgur Burak M, Berberian John, Aryan Henry E, Meltzer Hal S, Levy Michael L
Pediatric Neurosurgery, Children's Hospital of San Diego, San Diego, CA 92123, USA.
Surg Neurol. 2006 Jul;66(1):18-25. doi: 10.1016/j.surneu.2005.12.003.
Cerebellar mutism (CM) is a postoperative complication of mainly pediatric posterior fossa surgery. Multiple theories exist for explaining this phenomenon. We have made an attempt to further understand this entity given a particularly interesting case as it relates to multiple pathophysiologic pathways.
We have reviewed the details surrounding a particularly interesting case of CM. A retrospective analysis of this patient's clinical history and recovery is described. An extensive literature review has been performed in conjunction with an attempt to help elucidate details and a better understanding of CM.
A thorough analysis of existing theories as to the pathophysiologic mechanism of CM has been performed as it relates to the details of this particular case. A case is described in which a child exhibiting CM abruptly improved and made a relatively quick recovery after the triggering of the melodic speech pathway by way of watching and beginning to sing along with a video. It appears that this incident involving a familiar song catalyzed various speech pathways, which apparently were in some state of shock. This phenomenon seems to be a temporary entity involving not only the mechanical coordination of speech production, but also the initiation of speech itself.
Evidence exists for a pathophysiologic pathway for speech by way of coordinating phonation and articulation. In addition, there seems to exist a pathway by which the initiation of speech may be altered or halted by posterior fossa pathology, namely, vermian or dentate nuclear injury. In particular to this case, we found that the incidental appreciation of other forms of speech, melodic in this instance, may be the key to help stimulate and accelerate the recovery from CM.
小脑缄默症（CM）是主要发生于小儿后颅窝手术后的一种并发症。关于这一现象存在多种理论解释。鉴于一个与多种病理生理途径相关的特别有趣的病例，我们试图进一步了解这一病症。
我们回顾了一个特别有趣的CM病例的相关细节。描述了对该患者临床病史及恢复情况的回顾性分析。同时进行了广泛的文献综述，以帮助阐明细节并更好地理解CM。
针对CM病理生理机制的现有理论，结合该特定病例的细节进行了深入分析。描述了这样一个病例：一名表现为CM的儿童在通过观看并开始跟着视频一起唱歌触发旋律性言语通路后，突然好转并较快康复。似乎这一涉及熟悉歌曲的事件催化了各种言语通路，而这些通路显然处于某种休克状态。这种现象似乎是一个暂时的情况，不仅涉及言语产生的机械协调，还涉及言语本身的启动。
有证据表明存在一条通过协调发声和发音来实现言语的病理生理途径。此外，似乎存在一条途径，后颅窝病变，即蚓部或齿状核损伤，可改变或停止言语的启动。就该病例而言，我们发现偶然欣赏其他形式的言语，在本例中为旋律性言语，可能是帮助刺激并加速从CM恢复的关键。
