title: Visual impairment associated with mutism after posterior fossa surgery in children.
abstract: OBJECTIVE
  To report four children with visual impairment associated with mutism after posterior fossa surgery. Mutism after posterior fossa surgery is a well-described phenomena, but to our knowledge, visual impairment has not been reported in association with it.
  
  
  METHODS
  Record review of four children (age range, 3-7 yr) who underwent posterior fossa surgery (via suboccipital craniotomies) for removal of a medulloblastoma (three patients) or ependymoma (one patient). Each presented with headache, ataxia, or nausea and vomiting, but none had preoperative visual complaints other than diplopia. Postoperatively, all patients were mute, and because of apparent visual loss, neuro-ophthalmic consultation was requested. Postoperative scans and examinations were also reviewed.
  
  
  RESULTS
  Each child was awake but appeared withdrawn without verbal output. No child blinked to threat or fixed or followed. In each case, pupillary reactivity was normal, and funduscopic examinations revealed only papilledema. One child reached for money. Within weeks or months postoperatively, the mutism spontaneously resolved, and visual behavior in general improved, roughly in parallel. During the follow-up period, papilledema resolved and the disc color was normal in each case. Magnetic resonance images obtained postoperatively revealed nothing remarkable, except surgical defects, without lesions in the retrogeniculate pathway.
  
  
  CONCLUSIONS
  Impaired visual behavior, mimicking cortical visual loss, may be associated with mutism after posterior fossa surgery in children. The prognosis for recovery is excellent and parallels the return of normal speech. The mechanism is unclear.
authors.affiliation: Department of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
authors.forename: G T
authors.initials: GT
authors.lastname: Liu
authors.forename: P C
authors.initials: PC
authors.lastname: Phillips
authors.forename: P T
authors.initials: PT
authors.lastname: Molloy
authors.forename: M N
authors.initials: MN
authors.lastname: Needle
authors.forename: S L
authors.initials: SL
authors.lastname: Galetta
authors.forename: L J
authors.initials: LJ
authors.lastname: Balcer
authors.forename: L
authors.initials: L
authors.lastname: Schut
authors.forename: A C
authors.initials: AC
authors.lastname: Duhaime
authors.forename: L N
authors.initials: LN
authors.lastname: Sutton
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery*; D002526:Cerebellar Diseases / Q000150:complications / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior; D004806:Ependymoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000601:surgery*; D009155:Mutism / Q000150:complications / Q000209:etiology*; D011183:Postoperative Complications; D011184:Postoperative Period; D012075:Remission, Spontaneous; D014786:Vision Disorders / Q000150:complications / Q000209:etiology* / Q000503:physiopathology