Crossed cerebellocerebral diaschisis in patients with cerebellar stroke

Komaba, Yuichi; Osono, Eiichi; Kitamura, Shin; Katayama, Yasuo

doi:10.1034/j.1600-0404.2000.00002.x

Cited by 51 publications

(27 citation statements)

References 2 publications

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“…Observations of crossed cerebellar hypoperfusion after cortical stroke and crossed cerebello-cerebral diaschisis in patients with cerebellar stroke give further evidence for the CTCC circuit. This may have implications for the cerebello-cerebral interactions in emotion regulation, particularly since emotion regulation is considered a function of the frontal cortex [43,44]. Daskalakis and colleagues applied paired-pulse TMS and showed reduced cerebellothalamo-cortical inhibition in schizophrenic patients, providing the first direct evidence for a link between behavioral dysregulation and disturbed communication between the cerebellum and frontal cortex [45].…”

Section: Discussionmentioning

confidence: 99%

The Cerebellum in Emotion Regulation: A Repetitive Transcranial Magnetic Stimulation Study

2008

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Several lines of evidence suggest that the cerebellum may play a role in the regulation of emotion. The aim of this study was to investigate the hypothesis that inhibition of cerebellar function using slow repetitive transcranial magnetic stimulation (rTMS) would lead to increased negative mood as a result of impaired emotion regulation. In a randomized counterbalanced within-subjects design, 12 healthy young right-handed volunteers received 20 min of cerebellar, occipital, or sham 1 Hz rTMS on three separate days. Mood state inventories were acquired prior to and immediately after rTMS and after an emotion regulation task (ERT). In the ERT, participants were instructed to either look at aversive and neutral scenes, or to suppress the negative feelings experienced while watching aversive scenes during which the electroencephalogram (EEG) was recorded. Results showing no changes in baseline-corrected mood were observed immediately after rTMS. However, significant increases in baseline-corrected negative mood following the ERT were reported after cerebellar rTMS exclusively. No effects on the EEG during the ERT were observed. These findings provide support for the view that the cerebellum is implicated in the regulation of emotion and mood, and concur with evidence of cerebellar abnormalities observed in disorders associated with emotion dysregulation. In order to clarify the underlying biological mechanisms involved, more research is needed.

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Section: Discussionmentioning

confidence: 99%

The Cerebellum in Emotion Regulation: A Repetitive Transcranial Magnetic Stimulation Study

2008

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“…In contrast to the well-recognized crossed cerebellar diaschisis, CCCD refers to a regional depression of cerebral blood flow in the supratentorial areas due to a contralateral cerebellar lesion [14]. It has been suggested that unilateral cerebellar infarcts can influence nonmotor cognitive functions, and these neuropsychological deficits are explained by CCCD [15].…”

Section: Discussionmentioning

confidence: 99%

Frequency and Clinical Significance of Acute Bilateral Cerebellar Infarcts

et al. 2008

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Background: Unlike acute unilateral cerebellar infarct (UCI), acute bilateral cerebellar infarcts (BCI) have attracted little attention. To evaluate the clinical significance of BCI, we compared UCI and BCI and analyzed potentially prognostic factors. Methods: Patients who were consecutively admitted at a university hospital over a 4-year period with acute cerebellar infarcts, proven by diffusion-weighted imaging, were studied. Cerebellar infarcts were topographically classified, and divided into 2 groups: UCI and BCI. The demographics, involved territories, concomitant lesions outside the cerebellum (CLOC), bilateral involvement, infarct volume, hospital courses, and mechanisms were analyzed. We performed multiple regression analysis to predict the poor outcome at discharge [≧3 on the modified Rankin Scale (mRS)]. Results: Among 162 patients with acute cerebellar infarcts, 31% (n = 50) were BCI. Territorial infarcts were 74% (n = 120) and non-territorial infarcts 26% (n = 42) of the total. Posterior inferior cerebellar artery infarcts were the most common, and combined-territorial infarcts were the rarest. Baseline demographics were not significantly different between UCI and BCI, except for initial stroke severity (modified NIH Stroke Scale and infarct volume) and diabetes. Large-artery atherosclerosis was significantly higher in BCI, whereas undetermined causes were higher in UCI (p = 0.028). By multiple regression analysis, BCI was the only independent radiological factor for poor prognosis (odds ratio, 6.96; 95% CI, 1.80–26.92), and represented a significantly more unstable hospital course, longer hospital stay, worse mRS at discharge, and higher mortality. Conclusions: In acute cerebellar infarcts, bilateral involvement is common and appears to be a superior determinant for early prognosis rather than territories involved or CLOC.

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“…Another recent hypothetical explanation for the PFS is the phenomenon of cerebellocerebral diaschisis. This phenomenon [55, 56] represents perfusional defects in a distant but anatomically and functionally connected supratentorial region, reflecting the metabolic impact of the cerebellar lesion on supratentorial structures, due to the lack of excitatory impulses [57]. Several studies have shown blood flow alterations in supratentorial structures in patients with cerebellar lesions and associated supratentorial cognitive and language dysfunctions [58,59,60].…”

Section: Discussionmentioning

confidence: 99%

Posterior Fossa Syndrome after a Vermian Stroke: A New Case and Review of the Literature

et al. 2007

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The posterior fossa syndrome (PFS) is a well-known clinical consequence of posterior fossa surgery that has only been reported in a limited number of cases with a nontumoral etiology. It consists of transient cerebellar mutism, behavioral abnormalities and personality changes. We describe a 12-year-old child who developed transient cerebellar mutism associated with behavioral and emotional symptoms following rupture of a vermis arteriovenous malformation (AVM). Following the stroke, the girl experienced a 24-hour symptom-free interval. After that, she became mute and her emotional state was characterized by severe anxiety, irritability and withdrawal. After 3 days, mutism resolved and dysarthria became apparent. Two weeks after stroke, the AVM was surgically removed and the postoperative course was uneventful. This case is the first reported in which the PFS occurred after focal nonsurgically induced cerebellar damage.

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Crossed cerebellocerebral diaschisis in patients with cerebellar stroke

Abstract: This CCCD phenomenon is important to be aware of in clinical reading of images.

Cited by 51 publications

References 2 publications

The Cerebellum in Emotion Regulation: A Repetitive Transcranial Magnetic Stimulation Study

The Cerebellum in Emotion Regulation: A Repetitive Transcranial Magnetic Stimulation Study

Frequency and Clinical Significance of Acute Bilateral Cerebellar Infarcts

Posterior Fossa Syndrome after a Vermian Stroke: A New Case and Review of the Literature

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