OMS4 Liberty University College of Osteopathic Medicine Forest, Virginia, United States
Case Diagnosis: Posterior Fossa Syndrome secondary to removal of cerebellar mass.
Case Description: A 15-year-old male patient presented to the ED with new onset diplopia and nausea.Patient reported over the past month he has had sinusitis, headaches, and pulsatile tinnitus.Patient noted that the headaches were continual and medication provided minimal relief.The headaches worsened in the morning and when laying down.They would also wake him from sleep. In the ED patient had an unremarkable neurologic exam, aside from visual testing. He was sent to imaging: CT head showed an intracranial mass obstructing the fourth ventricle with associated hydrocephalus.Patient underwent a suboccipital craniotomy the next morning.After surgery, the patient was able to communicate verbally with “yes” and “no” answers.Three days later he was no longer able to verbalize, could not follow commands, and was unable to move on his own. Patient was transferred to inpatient rehab due to post surgical course complication of posterior fossa syndrome.
Discussions: Posterior Fossa Syndrome, also known as cerebellar mutism or cerebellar cognitive affect syndrome is a post-surgical complication of cerebellar mass resection.The cause of this set of symptoms is believed to be from interruption of the brain’s communication from the cerebellum to the thalamus.Symptoms that point to this condition are mutism and cranial nerve palsies.In more severe cases the condition can also affect movement and attention.Rehab consisting of SLP, OT, and PT are integral parts to the recovery process.
Conclusions: Although the typical presentation of Posterior Fossa Syndrome tends to develop a day or two after the surgery, it can appear later as shown in this patient.Clinicians should consult inpatient rehab promptly to begin therapies once this syndrome is identified.
