Complete mutism after midbrain periaqueductal gray lesion

Antonio Esposito, Guy Demeurisse, Barbara Alberti, Franco Fabbro

Research output: Contribution to journalArticlepeer-review


Several neurophysiological studies have highlighted the role of the midbrain periaqueductal gray matter (PAG) in the initiation of vocalization in various animal species, from frogs to primates. With regard to humans, only two cases of complete mutism following a lesion to the PAG have been reported so far. This article describes a new case of a patient (GM) who, following an ischemic lesion to the periaqueductal gray region of the midbrain, presented with complete and irreversible mutism, though her language comprehension functions and her non-verbal expression capacity were preserved. This clinical case provides evidence that in humans the PAG also acts as a link between different vocalization-eliciting external and internal stimuli (which reach the PAG from sensory and emotional structures) and the vocal-motor coordinating mechanisms in the lower brain stem.

Original languageEnglish
Pages (from-to)681-685
Number of pages5
Issue number4
Publication statusPublished - Mar 17 1999


  • Emotion
  • Midbrain
  • Mutism
  • Periaqueductal gray
  • Speech
  • Vocalization

ASJC Scopus subject areas

  • Neuroscience(all)


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