Cognitive and Affective Disturbances Following Focal Brainstem Lesions: A Review and Report of Three Cases

Abstract

Although insights in cerebellar neurocognition and affect are continuously growing, little is known about the role of the brainstem in cognitive and behavioural processing. In this paper, it is hypothesized that the brainstem is an inherent functional part of the cerebellocerebral network subserving cognition and affect, and that isolated brainstem damage may cause a constellation of symptoms closely resembling the cerebellar cognitive affective syndrome (CCAS) following cerebellar pathology. In order to investigate these premises, the available literature on cognitive and affective disturbances following brainstem lesions was critically reviewed starting from the pioneer descriptions in the 1950s till June 2012. Three personal cases were added to a study group of 75 cases with isolated vascular brainstem damage. In a cohort of 30 patients that allowed construction of anatomoclinical correlations in a reliable way, a range of cognitive and behavioural symptoms, typically associated with impairment of cortical or limbic areas, were identified. Executive dysfunction, attentional deficits and a decline in general intellectual capacity represent the most common cognitive findings, but memory, visuospatial skills, language and praxis may be impaired as well. Almost half of the cases presented with behavioural or affective changes. Analysis of SPECT findings indicates that functional suppression of frontal, parietal and to a lesser extent also the temporal areas are common phenomena after isolated brainstem stroke. As reflected by diaschisis affecting the cerebellocerebral network, a loss of excitatory input from the brainstem to the cerebellum and cerebrum may induce disruption of several cortical regions as well as emotional control centres resulting in and a constellation of symptoms closely resembling the CCAS. The pathophysiological mechanism underlying brainstem-induced cognitive and affective disturbances is discussed.

The Supplementary Motor Area Responsible for Word Retrieval Decline After Acute Thalamic Stroke Revealed by Coupled SPECT and Near-Infrared Spectroscopy

“…Three patients (TH6, 11,14) were available for follow-up NIRS data. NIRS was performed three times for TH6, and two times for TH11 and TH14, respectively.…”

Brainstem enlargement in preschool children with autism: Results from an intermethod agreement study of segmentation algorithms

“…A 2-year longitudinal study investigating the brainstem volume showed an atypical development in children and adolescents with ASD compared to matched controls, characterized by an increase of GM brainstem volume over time (Jou et al, 2013). Moreover, recent lesion studies suggested an involvement of the brainstem in neurocognition (D'Aes et al, 2015), and specifically a cognitive dysfunction after brainstem damage (Fu et al, 2017): thus, it is crucial to analyze the impact of IQ level on brainstem volume. Moreover, recent lesion studies suggested an involvement of the brainstem in neurocognition (D'Aes et al, 2015), and specifically a cognitive dysfunction after brainstem damage (Fu et al, 2017): thus, it is crucial to analyze the impact of IQ level on brainstem volume.…”

“…Further, both quantitative and qualitative sex differences have been detected in the neuroanatomy of children (Retico et al, 2016) and adults (Ecker et al, 2017) with ASD, and the brainstem is part of such sexually dimorphic brain regions (Lai et al, 2013). Moreover, recent lesion studies suggested an involvement of the brainstem in neurocognition (D'Aes et al, 2015), and specifically a cognitive dysfunction after brainstem damage (Fu et al, 2017): thus, it is crucial to analyze the impact of IQ level on brainstem volume. None of the previous studies on brainstem structural MRI in ASD individuals has addressed this issue, and more broadly low-functioning children have been neglected in neuroanatomical autism research (Jack & Pelphrey, 2017).…”

Rehabilitation for a Patient with Hemiplegia, Ataxia, and Cognitive Dysfunction Caused by Pontine Hemorrhage

“…Cognitive impairment caused by pathological changes in the brain stem has been gaining attention recently. D'aes and Mariën [ 8 ] reviewed 75 patients who had experienced brain stem stroke and also examined 3 additional patients and reported that affected cognitive functions such as decline in general intellectual capacity, attention, executive functions, memory, visuospatial skills, language, and praxis were observed. Hoffmann and Watts [ 9 ] reported that cognitive impairment was found in the acute phase of brain stem stroke, along with a reduction of blood flow to the frontal and parietal lobes.…”