1/59. Transient mutism resolving into cerebellar speech after brain stem infarction following a traumatic injury of the vertebral artery in a child.A 3.7-year-old girl presented with an anterior neck injury followed by progressive subcutaneous emphysema and loss of consciousness. After resuscitation, a laceration on the first tracheal cartilage was closed surgically. As she was extubated one week later, she was found to have right hemiplegia and muteness. MRI showed a T2-bright lesion on the tegmentum of the left midbrain down to the upper pons. Right vertebral angiography disclosed an intimal flap with stenosis at the C3 vertebral level presumably caused by a fracture of the right C3 transverse process later confirmed in a cervical 3D-CT scan. Her muteness lasted for 10 days, after which she began to utter some comprehensible words in a dysarthric fashion. Her neurological deficits showed improvement within 3 months of her admission. Transient mutism after brain stem infarction has not been reported previously. We discuss the anatomical bases for this unusual reversible disorder in the light of previous observations and conclude that bilateral damage to the dentatothalamocortical fibers at the decussation of the superior cerebellar peduncle may have been responsible for her transient mutism.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
2/59. Selective mutism--the child who doesn't speak at school.Selective mutism is a syndrome in which there is a consistent failure to speak in social situations where speech is expected, despite speaking in other situations. The problem is most common in the child who speaks actively and well at home but who refuses to speak in school. This paper describes 2 young children from the author's practice who refuse to speak at school and a short summary of recent changes in the thinking about the cause and therapy of selective mutism. This is the first article on selective mutism to appear in an American pediatric journal.- - - - - - - - - - ranking = 0.25keywords = speech (Clic here for more details about this article) |
3/59. diffusion-weighted MRI in acute mutism.mutism defined as a complete loss of speech may be related to psychiatric or neurologic disorders. The ischemic stroke origins of mutism are often difficult to assess at the acute stage. Accordingly, the search for the underlying mechanism as the localization of the damages may be difficult by conventional radiological techniques. diffusion-weighted (DWI) MRI may accurately identify patients with acute ischemic stroke and distinguish them from those who mimic acute stroke better than clinical and conventional neuroradiological methods. This report aims to demonstrate the utility of DWI-MRI in the diagnosis of acute mutism.- - - - - - - - - - ranking = 0.25keywords = speech (Clic here for more details about this article) |
4/59. The successful treatment of long-term selective mutism: a case study.This study describes the successful treatment of a seventh grade boy who had selective mutism in school since kindergarten. Treatment consisted of systematic desensitization, consultation with school personnel, and training in social speaking skills. The student made significant gains with respect to frequency of verbalizations to teachers and peers, number of individuals spoken to, anxiety related to speaking, school attendance, and involvement in school-based extracurricular activities. At one year follow-up, the student's rate of speech was indistinguishable from his classmates'. Special issues concerning the treatment of long-term selective mutism are discussed.- - - - - - - - - - ranking = 0.25keywords = speech (Clic here for more details about this article) |
5/59. tacrolimus-associated mutism after orthotopic liver transplantation.BACKGROUND: mutism/speech apraxia has been well documented as a toxic effect of cyclosporine after liver transplantation but has been reported only rarely with tacrolimus. Brain imaging with magnetic resonance or computed tomography has failed to demonstrate abnormalities in affected patients. methods: We present the first example of an acute onset of loss of speech associated with a sudden elevation of serum tacrolimus level after successful orthotopic liver transplantation. We also describe the positron emission tomography (PET) scan of this patient's brain. RESULTS: PET scan imaging of the brain was abnormal, demonstrating decreased metabolism in the posterior temporo-parieto-occipital regions. Statistical probability mapping revealed additional areas of hypometabolism in the cingulate gyrus. CONCLUSIONS: PET scan revealed abnormalities of the brain in a patient with tacrolimus-induced mutism. The cingulate gyrus may play a role in the mutism/speech apraxia syndrome seen with cyclosporine/tacrolimus neurotoxicity.- - - - - - - - - - ranking = 0.75keywords = speech (Clic here for more details about this article) |
6/59. Cerebellar mutism associated with a midbrain cavernous malformation. Case report and review of the literature.The authors report a case of cerebellar mutism arising from a hemorrhagic midbrain cavernous malformation in a 14-year-old boy. No cerebellar lesion was identified; however, edema of the dorsal midbrain was noted on postoperative magnetic resonance images. Dysarthric speech spontaneously returned and then completely resolved to normal speech. This case provides further evidence for the theory that involvement of the dentatothalamic tracts, and not a cerebellar lesion per se, is the underlying cause of "cerebellar" mutism.- - - - - - - - - - ranking = 0.5keywords = speech (Clic here for more details about this article) |
7/59. Elective mutism in a first grader: the remediation of a complex behavioral problem.Teachers frequently deal with unusual and perplexing behavioral problems in their classes. This study demonstrates how spontaneous and prompted speech were produced in a six-year-old mute by a first-grade teacher and her aide. A reinforcement system for peer-prompted speech and spontaneous speech was employed in three separate school classes in a multiple-baseline fashion. The reinforcement system produced prompted and spontaneous speech in each situation. Postchecks in the second grade indicated the child was still speaking and conversing spontaneously with his peers. This study suggests a method that teachers can use in the classroom to deal with this severely handicapping condition.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
8/59. tacrolimus (FK506)-induced mutism after liver transplant.tacrolimus (FK506), an immunosuppressant, has been associated with mutism in adults after liver transplant. speech arrest, agitation, tremor, ataxia, and downward gaze deviation in a 5-year-old female 13 days after orthotopic liver transplant are reported. FK506, which began to be administered 12 days earlier, rose to a level of 44 ng/mL (normal range, 10-20 ng/mL) 1 day before neurologic abnormalities began. FK506 dose level was maintained and then reduced. Three days later the patient could say a few single words and extra-ocular movement returned to normal. Four months later, she continued to exhibit decreased fluency and dysarthria with ataxia. One year later, decreased fluency and mild ataxia persists. Rapid identification of speech loss linked to FK506 may be important because reduction or cessation of the drug may be associated with reverse of speech loss.- - - - - - - - - - ranking = 0.5keywords = speech (Clic here for more details about this article) |
9/59. Transient loss of speech followed by dysarthria after removal of posterior fossa tumour.The authors report three children who suffered transient loss of speech during six to eight weeks following removal of a large midline cerebellar tumour. None manifested speech difficulties immediately after surgery, but all developed mutism within 24 to 48 hours. The speech of all children slowly but completely recovered, after a period of severe dysarthria. The re-organization of speech functions is discussed in relation to the functioning of musculature.- - - - - - - - - - ranking = 2keywords = speech (Clic here for more details about this article) |
10/59. Transient cerebellar mutism in the course of acute cerebellitis.Transient mutism after posterior fossa surgery in children or associated with cerebellar hemorrhage or trauma is a recognized phenomenon. However, its association with parainflammatory cerebellitis has been rarely described. We report on a previously healthy 3-year-old child with severe cerebellitis after acute gastroenteritis of unidentified cause. Severe ataxia and transient mutism were the prevailing clinical features. magnetic resonance imaging revealed swelling of the cerebellum with protruding cerebellar tonsils at the level of the occipital foramen. Recovery from the acute illness was slow and incomplete. Residual cerebellar dysfunction manifested with dysphonic and dysarthric speech, as well as motor coordination problems and was associated with atrophy of the vermis and cerebellar hemispheres in follow-up studies.- - - - - - - - - - ranking = 0.25keywords = speech (Clic here for more details about this article) |
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