Clinical Manifestations of Cerebellar Disease

Javalkar, Vijayakumar; Khan, Misbba; Davis, Debra

doi:10.1016/j.ncl.2014.07.012

Cited by 17 publications

(8 citation statements)

References 27 publications

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“…The affected body part with cerebellar tremor is usually unilateral, segmental or multifocal, rather than focal or generalized [ 3 ]. Another form of cerebellar tremor is titubation, which normally appears in the trunk or head [ 27 ].…”

Section: Clinical Features (Phenomenology)mentioning

confidence: 99%

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Movement Disorders Following Cerebrovascular Lesions in Cerebellar Circuits

Choi¹

2016

JMD

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Cerebellar circuitry is important to controlling and modifying motor activity. It conducts the coordination and correction of errors in muscle contractions during active movements. Therefore, cerebrovascular lesions of the cerebellum or its pathways can cause diverse movement disorders, such as action tremor, Holmes’ tremor, palatal tremor, asterixis, and dystonia. The pathophysiology of abnormal movements after stroke remains poorly understood. However, due to the current advances in functional neuroimaging, it has recently been described as changes in functional brain networks. This review describes the clinical features and pathophysiological mechanisms in different types of movement disorders following cerebrovascular lesions in the cerebellar circuits.

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Section: Clinical Features (Phenomenology)mentioning

confidence: 99%

“…The pathophysiology of cerebellar tremor is not yet thoroughly understood, but it is believed to be related to dysfunction of the cerebellar efferent pathways [ 27 ]. These pathways include the dentato-rubrothalamo-cortical and dentato-rubro-olivary circuits.…”

Section: Clinical Features (Phenomenology)mentioning

confidence: 99%

Movement Disorders Following Cerebrovascular Lesions in Cerebellar Circuits

Choi¹

2016

JMD

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“…Location of lesions in patients with stroke and brain tumors helps to delineate structural and functional connections between brain and cerebellum. Cerebellar mutism is a classic example for this and has been well described in children with posterior fossa midline tumors after surgery (Javalkar et al ; van Baarsen and Grotenhuis ; Patay ; Gudrunardottir et al ; Helton et al ; Wibroe et al ; Makarenko et al ). It is hypothesized that mutism is secondary to disruption of cerebro‐cerebellar functional connections in the superior cerebellar peduncle (van Baarsen and Grotenhuis ).…”

Section: Introductionmentioning

confidence: 99%

Functional MRI activation patterns of cerebellum in patients with epilepsy and brain tumors

Zacharia

Eslinger

2019

Clinical Anatomy

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Function of cerebellum in control and coordination of motor function has been well established for several years. Recent functional magnetic resonance imaging (MRI) studies reveal activation of cerebellum with memory, speech and language tasks. We hypothesize that during every function in the brain signals are relayed to cerebellum. We seek to analyze cognitive, emotional and social functions of cerebellum in patients with brain tumors and epilepsy utilizing functional Magnetic Resonance Imaging. Fifty-one consecutive adult patients who underwent functional MRI examination were retrospectively analyzed for various activation patterns involving cerebellum. The neuropsychological battery of tasks assessed motor, language, memory, visual and auditory functions. Cognitive ability of all participants was assessed by Montreal cognitive assessment (MOCA). Patterns were analyzed for specific lobes and locations in the cerebellum. We found that simultaneous cerebellar activation is a consistent finding with brain activation during every functional MRI task that we tested except visual task. The patterns of functional MRI cerebellar activation were similar in both patient subgroups and control subjects compared to previously described patterns in normal subjects.

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“…Typical intention and postural tremor are presumably generated within the dentato-rubro-thalamo-cortical or the dentato-rubro-olivary circuits ( Choi, 2016 ). The pathophysiology of cerebellar tremor is not yet thoroughly understood, but it is believed to be related to dysfunction of the cerebellar efferent pathways ( Javalkar et al, 2014 ; Choi, 2016 ). The denomination of Holmes’ tremor has been ascribed to an unusual combination tremor syndrome involving the proximal and distal parts of the upper extremities with rest tremor that is more severe on postural maintenance and most severe at kinetic intention ( Puschmann and Wszolek, 2011 ; Kipfer and Frigerio, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Dual Target Deep Brain Stimulation With Externalized Programming for Post-traumatic Complex Movement Disorder

et al. 2021

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Introduction: Movement disorders can be common, persistent, and debilitating sequelae of severe traumatic brain injury. Post-traumatic movement disorders are usually complex in nature, involving multiple phenomenological manifestations, and can be difficult to control with medical management alone. Deep brain stimulation (DBS) has been used to treat these challenging cases, but distorted brain anatomy secondary to trauma can complicate effective targeting. In such cases, use of diffusion tractography imaging and inpatient testing with externalized DBS leads can be beneficial in optimizing outcomes.Case Description: We present the case of a 42-year-old man with severe, disabling post-traumatic tremor who underwent bilateral, dual target DBS to the globus pallidus internus (GPi) and a combined ventral intermediate nucleus of the thalamus (Vim)/dentato-rubro-thalamic tracts (DRTT) target. DRTT fiber tracts were reconstructed preoperatively to assist in surgical targeting given the patient’s distorted anatomy. Externalization and survey of the four leads extra-operatively with inpatient testing allowed for internalization of the leads that demonstrated benefit. Six months after surgery, the patient’s tremor and dystonic burden had decreased by 67% in the performance sub-score of The Essential Tremor Rating Scale (TETRAS).Conclusion: A patient-tailored approach including target selection guided by individualized anatomy and tractography as well as extra-operative externalized lead interrogation was shown to be effective in optimizing clinical outcome in a patient with refractory post-traumatic tremor.

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Clinical Manifestations of Cerebellar Disease

Cited by 17 publications

References 27 publications

Movement Disorders Following Cerebrovascular Lesions in Cerebellar Circuits

Movement Disorders Following Cerebrovascular Lesions in Cerebellar Circuits

Functional MRI activation patterns of cerebellum in patients with epilepsy and brain tumors

Case Report: Dual Target Deep Brain Stimulation With Externalized Programming for Post-traumatic Complex Movement Disorder

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