Cerebellar cognitive affective syndrome after acute cerebellar stroke

Abstract

IntroductionThe cerebellum modulates both motor and cognitive behaviors, and a cerebellar cognitive affective syndrome (CCAS) was described after a cerebellar stroke in 1998. Yet, a CCAS is seldom sought for, due to a lack of practical screening scales. Therefore, we aimed at assessing both the prevalence of CCAS after cerebellar acute vascular lesion and the yield of the CCAS-Scale (CCAS-S) in an acute stroke setting.Materials and methodsAll patients admitted between January 2020 and January 2022 with acute onset of a cerebellar ischemic or haemorrhagic first stroke at the CUB-Hôpital Erasme and who could be evaluated by the CCAS-S within a week of symptom onset were included.ResultsCerebellar acute vascular lesion occurred in 25/1,580 patients. All patients could complete the CCAS-S. A definite CCAS was evidenced in 21/25 patients. Patients failed 5.2 ± 2.12 items out of 8 and had a mean raw score of 68.2 ± 21.3 (normal values 82–120). Most failed items of the CCAS-S were related to verbal fluency, attention, and working memory.ConclusionA definite CCAS is present in almost all patients with acute cerebellar vascular lesions. CCAS is efficiently assessed by CCAS-S at bedside tests in acute stroke settings. The magnitude of CCAS likely reflects a cerebello-cortical diaschisis.

Characteristics of Cerebellar Cognitive Affective Syndrome in patients with acute cerebellar stroke and its impact on outcome

“…Low scores on the phonemic uency and verbal recall items may be due to advanced age. In a previous study by Abderrakib et al 11 category switching and backward digit span were the most commonly failed items, followed by phonemic uency and verbal recall. The mean age was 64 years, which is younger than that in our study, and the results were based on the original cutoff value.…”

“…9,10 In contrast, very few studies utilizing the CCAS-S in acute stroke patients have been conducted, and only one has investigated the prevalence of CCAS and the utility of CCAS-S in stroke patients. 11 Therefore, this study aimed to investigate the characteristics of CCAS in acute cerebellar stroke patients using the CCAS-S. In addition, we investigated the relationship between the CCAS-S and physical function, activities of daily living (ADL), length of hospital stay, and outcome.…”

Reduced cerebral blood flow and cognitive dysfunction following isolated cerebellar infarction: two case reports

“…However, these patients showed milder cognitive deficits than those in a previous study. 20 One possible explanation for this discrepancy is that our report only included patients with cerebellar infarction, whereas the previous study also included patients with cerebellar hemorrhage, which is usually accompanied by cerebral edema and may lead to severe cognitive deficits. In keeping with prior voxel-lesion symptom-mapping studies in patients with cerebellar ischemic infarction, [21][22][23] cognitive changes were associated with lesions in lobules VII and VIII in the present study.…”

Infarct‐related structural disconnection and delirium in surgical aortic valve replacement patients

“…[36][37][38] Non-motor deficits arising from lesions damaging the cortico-cerebellar connection, such as the cognitive abnormalities seen in patients with cerebellar cognitive affective syndrome (aka. Schmahmann's syndrome) 39 are routinely observed during delirium states (e.g., executive dysfunction, affective dysregulation, attention, and working memory impairment). 40,41 Our finding of increased perioperative DWI-ISD loss to the right inferior frontal gyrus of patients who developed POD is also intriguing, as this region has been identified as a central "hub" of the brain's salience functional network.…”

“…The pathophysiological mechanisms of this association are still relatively obscured, but the role of the cerebellum in brain network oscillatory activity via the cortico‐thalamo‐cerebellar pathway is one hypothesis, as dysfunction in this circuit can have a negative impact on interhemispheric communication and has been suggested as the basis for “dysmetria of thought.” 36 , 37 , 38 Non‐motor deficits arising from lesions damaging the cortico‐cerebellar connection, such as the cognitive abnormalities seen in patients with cerebellar cognitive affective syndrome (aka. Schmahmann's syndrome) 39 are routinely observed during delirium states (e.g., executive dysfunction, affective dysregulation, attention, and working memory impairment). 40 , 41 …”