Round 1 - Statements and Voting Results

Appendix II

Round 1 - Statements and Voting Results

R1Q1 – Cerebellar Mutism (CM) refers to transient loss or severe reduction of speech that follows lesions of the cerebellum as opposed to the cerebrum or lower cranial nerves. Its unique features are delayed onset (1 - 7 days) and limited duration (1 day - 2 or more years) followed by a recovery period where speech is marked by dysarthria.

Strongly agree 14/27 (51.85%)

Agree 7/27 (25.93%)

Agree with amendment 5/27 (18.52%)

Not sure if I agree or disagree 0/27 (0.00%)

Disagree (but really agree w/amendment) 1/27 (3.70%)

Support 96%

R1Q2 – CM is the hallmark characteristic of the more broad Posterior Fossa Syndrome (PFS)

Strongly agree 10/27 (37.04)

Agree 12/27 (44.44%)

Agree w/amendment 2/27 (7.41%)

Not sure if I agree or disagree 0/27 (0.00%)

Disagree 3/27 (11.11%)

Support 89%

R1Q3 - Symptoms of the PFS may occur within neuropsychological, neuropsychiatric and neurological domains, and are characterized by:

· language- and speech-related problems, including CM (see Q1 and Q2)

· cognitive impairment

· affective or behavioral symptoms or both

· motor problems

Strongly agree 13/27 (48.15%)

Agree 11/27 (40,74%)

Agree w/amendment 1/27 (3.70%)

Not sure if I agree or disagree 1/27 (3,70%)

Disagree 1/27 (3,70%)

Support 93%

R1Q4 - In addition to typical cerebellar signs (e.g. ataxia of gait, hypotonia, tremor, nystagmus), motor problems of the PFS can include hemiparesis and cranial nerve palsies.

Strongly agree 6/27 (22,22%)

Agree 8/27 (29,63%)

Agree w/amendment 1/27 (3.70%)

Not sure if I agree or disagree 7/27 (25.93%)

Disagree 5/27 (18,52%)

Support 56%

R1Q5 – Symptoms of the PFS may occur in different combinations and may vary in severity (NB one respondent skipped this question)

Strongly agree 17/26 (65.38%)

Agree 8/26 (30,77%)

Agree with amendment 1/26 (3.85%)

Not sure if I agree or disagree 0/26 (0.00%)

Disagree 0/26 (0.00%)

Support 100%

R1Q6 - The PFS is most commonly observed in children. It is rarely seen in adults.

Strongly agree 7/27 (25.93%)

Agree 11/27 (40.74%)

Agree with amendment 1/27 (3.70%)

Not sure if I agree or disagree 5/27 (18.52%)

Disagree 3/27 (11.11%)

Support 70%

R1Q7 - The PFS is most commonly observed after posterior fossa tumor surgery, but may also occur following trauma, vascular incidents and infections.

Strongly agree 12/27 (44.44%)

Agree 6/27 (22.22%)

Agree with amendment 0/27 (0,00%)

Not sure if I agree or disagree 6/27 (22.22%)

Disagree 3/27 (11.11%)

Support 67%

R1Q8 - In order to be diagnosed with the PFS, a patient needs to have CM + symptoms belonging to at least 2 out of the 3 following categories: cognitive, affective/ behavioral, motor.

Strongly agree 4/27 (14.81%)

Agree 10/27 (37.04%)

Agree with amendment 2/27 (7.41%)

Nor sure if I agree or disagree 4/27 (14.81%)

Disagree 7/27 (25.93%)

Support 59%

R1Q9 - To aid diagnosis, the following is recommended pre- and post-operatively in tumor patients and as soon as the PFS is suspected in non-tumor patients:

· MRI, preferably also DWI and DTI

· Full neurological examination

· Psychiatric evaluation (important to exclude delirium)

· Neuropsychological testing

· Speech and language assessment

· Systematic scoring of PFS symptoms with a specific PFS scoring scale (more about such a scale in Round 2)

Strongly agree 9/27 (33.33%)

Agree 9/27 (33.33%)

Agree with amendment 4/27 (14.81%)

Not sure if I agree or disagree 2/27 (7,41%)

Disagree 3/27 (11,11%)

Support 81%

R1Q10 - This first round has been dedicated to definition and diagnosis of PFS and CM. Round two will focus on monitoring of acute and late sequelae (follow-up) and the need for a new PFS scoring scale, but it will also allow for voting on other topics. Are there any other important statements that you think we should include?

No 20/27 (76.92%)

Yes 6/27 (23.08%)