Cerebellar compensation: a case of aphasia due to cerebellar hemorrhage

Abstract

Background Recently, patients with cognitive dysfunction due to cerebellar lesions (cerebellar cognitive affective syndrome [CCAS]) have been reported. Language impairments in CCAS are generally subtle; however, we encountered a patient who developed severe aphasia due to cerebellar hemorrhage. Case Report: A 77-year-old right-handed woman with heart failure was admitted to a nearby hospital. During hospitalization, she had a cerebral infarction of the left inferior parietal lobule and developed aphasia, characterized by phonemic paraphasia with repeated self-corrections and word-finding difficulty. After discharge, her symptoms gradually improved and she had no difficulty in her daily life. One year after the onset of cerebral infarction, the patient was admitted to our hospital with cerebellar ataxia and aphasia. Her aphasia symptoms were characterized by phonemic paraphasia with repeated self-corrections and word-finding difficulties, consistent with the symptoms that she developed on initial admission, as well as word comprehension deficits. Computed tomography revealed a hemorrhage in the right cerebellar hemisphere. Magnetic resonance imaging of the brain revealed no recent infarctions. Discussion Phonemic paraphasia with repeated self-correction is a characteristic symptom of left inferior parietal lobule lesions and has not been reported in patients with isolated cerebellar lesions. Thus, it is thought that the right cerebellar hemisphere compensated for the function of the left inferior parietal lobule after cerebral infarction and that functional compensation was disrupted due to a hemorrhage. This case report suggests that the underlying mechanisms of functional recovery from aphasia depend on the interplay between the cerebrum and the cerebellum.