Transient Mutism and Pathologic Laughter in the Course of Cerebellitis

• Published in: Pediatric neurology 2009-07, Vol.41 (1), p.49-52
• Main Authors: Dimova, Petia S., PhD, Bojinova, Veneta S., PhD, Milanov, Ivan G., DSci
• Format: Article
• Language: English
• Subjects: Anti-Inflammatory Agents - therapeutic use; Ataxia - etiology; Atrophy - pathology; Biological and medical sciences; Cerebellum - pathology; Child; Encephalitis - complications; Encephalitis - drug therapy; Encephalitis - pathology; Encephalitis - psychology; Female; Humans; Laughter; Magnetic Resonance Imaging; Medical sciences; Mutism - etiology; Neurology; Pediatrics; Recovery of Function; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2009.01.013

The phenomenon of cerebellar mutism with subsequent dysarthria is most commonly described as a part of posterior fossa syndrome after surgery for neoplasms in childhood. Pathologic laughter, on the other hand, is observed primarily in various neurologic diseases in adults. In the present case, a child manifested transient mutism and pathologic laughter during a severe cerebellitis. Headache, vertigo, and impaired consciousness developed during an acute respiratory infection. Thereafter, severe ataxia, mutism, and involuntary laughter became the main clinical features, as well as pyramidal signs. Magnetic resonance imaging revealed cerebellar swelling and T2 hyperintensity. During steroid treatment, a gradual vanishing of the pathologic laughter and improvement of the motor and speech functions occurred. Recovery was slow and incomplete, and follow-up magnetic resonance imaging showed cerebellar atrophy. This case confirms that mutism is a rare, but possible, manifestation in acute parainfectious cerebellitis and provides a novel example of pathologic laughter during this disease in childhood.