Transient improvement of the postoperative pediatric cerebellar mutism syndrome following intravenous midazolam injection

Abstract

Cerebellar mutism syndrome (CMS) is a postsurgical complication that occurs within days following posterior fossa surgery. It manifests with a speech impediment, emotional lability, or cognitive and motor abnormalities. So far, therapy for CMS consists of logopedic and neurological rehabilitation, with limited data on the efficacy of pharmacological treatment. Recently, a single case report suggested benzodiazepines’ (BDZ) efficacy in relieving CMS symptoms. In this paper, we report on a pediatric patient with a transient improvement of CMS symptoms after an intravenous administration of midazolam. A 12-year-old girl was operated on for a 4th ventricle tumor. Following surgical tumor resection, performed through a telovelar approach, the patient revealed dysarthria and ataxia, suggesting CMS. Control MRI has been performed, with prior intravenous midazolam injection. Within minutes following the BDZ injection, the patient's speech markedly improved. Within 2 h, the patient returned to her previous neurological condition. We presume that BDZ can positively act in CMS, which, however, still needs better evidence to support that hypothesis. A low dosage of intravenous midazolam was found effective. We found oral midazolam less effective than intravenously administered one. Further research is needed to prove the efficacy of benzodiazepines in alleviating CMS symptoms and to study the underlying mechanism.

Keywords

• Posterior fossa surgery
• Children
• Treatment
• Dentato-thalamo-cortical pathway
• Cerebellar mutism