Concurrence of Crossed Cerebellar Diaschisis and Parakinesia Brachialis Oscitans in a Patient with Hemorrhagic Stroke

Abstract

Crossed cerebellar diaschisis (CCD) is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to the supratentorial focal lesion. The phenomenon termed parakinesia brachialis oscitans (PBO) in which stroke patients experience involuntary stretching of the hemiplegic arm during yawning is rarely reported. The concurrence of CCD and PBO has never been described. A 52-year-old man had putaminal hemorrhage and demonstrated no significant recovery in his left hemiplegia after intensive rehabilitation, but his gait improved gradually. Two months after the stroke, the single photon emission computed tomography (SPECT) showed CCD. Four months after the stroke, the patient noticed PBO. The follow-up SPECT showed persistent CCD and the patient's arm was still plegic. The frequency and intensity of PBO have increased with time since the stroke. We speculate that the two phenomena CCD and PBO might share similar neuroanatomical pathways and be valuable for predicting clinical recovery after stroke.

Crossed cerebellar diaschisis after stroke detected noninvasively by arterial spin-labeling MR imaging

“…Previous studies found that CCD is a secondary neuronal depression which attributed to disruption of the corticoponto-cerebellar pathways with consecutive cerebellar functional inactivation [6]. The previous studies of CCD were frequently reported on single-photon emission CT (SPECT) [7] and positron-emission tomography (PET) [8]. However, the use of radioactive tracers and the high price limit their repeatability and application for healthy volunteers.…”

Rabbit syndrome in a neuroleptic naive patient with associated basal ganglia perfusion alterations treated with madopar fade‒out of perioral tremor after administration of L‒DOPA: role of thalamus in pathophysiology of post‒stroke rabbit syndrome

“…Several studies have demonstrated abnormal basal ganglia function in a variety of conditions, such as pain traumatic brain injury and various posture and movement disorders. [11][12][13][14][15][16][17][18][19][20] Extrapyramidal movement disorders, such as Huntington's chorea, Parkinson's disease and rabbit syndrome, have been described to involve decreased perfusion of the basal ganglia. 21,22 In contrast, increased perfusion of the basal ganglia has been described in patients with schizophrenia, especially in those with auditory hallucinations, 13 but it has never been described in patients with rabbit syndrome.…”