Postural asymmetry correlated with lateralization of cerebellar perfusion in persons with chronic stroke: A role of crossed cerebellar diaschisis in left side

Chang, Cheng-Chiang; Ku, Chih-Hung; Chang, Shin-Tsu

doi:10.1080/02699052.2016.1210229

Cited by 9 publications

(6 citation statements)

References 39 publications

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“…In acute stroke, in some cases, there will even be a compensatory hyperperfusion in the days following stroke 28 . In subacute and chronic stroke stages the compensatory adaptations of cerebral hemodynamic and collateral circulations are already activated, which can explain why, in our study, we did not find differences for CBF between the CCD(+) and CCD(–) groups 29,30 …”

Section: Discussionmentioning

confidence: 50%

Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the IpsilateralMCATerritory

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Piccirelli

et al. 2020

Magnetic Resonance Imaging

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Background In patients with steno‐occlusive disease, recent findings suggest that hemodynamic alterations may also be associated with crossed cerebellar diaschisis (CCD) rather than a functional disruption alone. Purpose To use a quantitative multiparametric hemodynamic MRI to gain a better understanding of hemodynamic changes related to CCD in patients with unilateral anterior circulation stroke. Study Type Prospective cohort study. Population Twenty‐four patients (25 datasets) with symptomatic unilateral anterior circulation stroke. Field Strength/Sequence 3T/two sequences: single‐shot (echo‐planar imaging) EPI sequence and T2* gradient echo perfusion‐weighted imaging study. Assessment The presence of CCD was inferred from the cerebellar asymmetry index (CAI) of the blood oxygenation‐level dependent cerebrovascular reactivity (BOLD‐CVR) exam, which was calculated from the mean BOLD‐CVR and standard deviation of the CAI of the healthy control group. For all perfusion‐weighted (PW)‐MRI parameters, the cerebellar and middle cerebral artery (MCA) territory asymmetry indices were calculated. Statistical Tests Independent Student's t‐test to compare the variables from the CCD positive(+) and CCD negative(–) groups and analysis of covariance (ANCOVA) to statistically control the effect of covariates (infarct volume and time since ischemia onset). Results CCD was present in 33% of patients. In the MCA territory of the affected hemisphere, BOLD‐CVR was significantly more impaired in the CCD(+) group as compared to the CCD(–) group (mean BOLD‐CVR ± SD [%BOLD signal/ΔmmHgCO2]: –0.03 ± 0.12 vs. 0.11 ± 0.13, P < 0.05). Moreover, the mean transit time (MTT) (asymmetry index (%) CCD(+) vs. CCD(–): 28 ± 23 vs. 4 ± 11, P < 0.05) and time to peak (TTP) (10 ± 10 vs. 2 ± 5, P < 0.05) in the MCA territory of the affected hemisphere were significantly prolonged, while cerebral blood volume was, on average, increased in the CCD(+) group (25 ± 15 vs. 4 ± 19, P < 0.05). Data Conclusion Our findings show that, in patients with symptomatic unilateral anterior circulation stroke, CCD is associated with hemodynamic impairment in the ipsilateral MCA territory, which further supports the concept of a vascular component of CCD. Level of Evidence 3 Technical Efficacy Stage 3

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Section: Discussionmentioning

confidence: 50%

Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the IpsilateralMCATerritory

Sebök

Niftrik

Piccirelli

et al. 2020

Magnetic Resonance Imaging

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“…Poor long-term outcomes in TBI, including headache, cognitive difficulties, and imbalance, may frequently co-exist with CCD [ 44 ]; therefore, long-term follow-up and specific interventions are important in patients with TBI [ 45 ]. Several studies have investigated the effect of specific interventions, such as iPBM on ischemia stroke; however, the consequences of these treatments on the occurrence of CCD in TBI remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Effects of intravascular photobiomodulation on cognitive impairment and crossed cerebellar diaschisis in patients with traumatic brain injury: a longitudinal study

Lin

Chang

et al. 2023

Lasers Med Sci

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The association between intravascular photobiomodulation (iPBM) and crossed cerebellar diaschisis (CCD) and cognitive dysfunction in patients with traumatic brain injury (TBI) remains unknown. We postulate that iPBM might enable greater neurologic improvements. The objective of this study was to evaluate the clinical impact of iPBM on the prognosis of patients with TBI. In this longitudinal study, patients who were diagnosed with TBI were recruited. CCD was identified from brain perfusion images when the uptake difference of both cerebella was > 20%. Thus, two groups were identified: CCD( +) and CCD( −). All patients received general traditional physical therapy and three courses of iPBM (helium–neon laser illuminator, 632.8 nm). Treatment assemblies were conducted on weekdays for 2 consecutive weeks as a solitary treatment course. Three courses of iPBM were performed over 2–3 months, with 1–3 weeks of rest between each course. The outcomes were measured using the Rancho Los Amigos Levels of Cognitive Functioning (LCF) tool. The chi-square test was used to compare categorical variables. Generalized estimating equations were used to verify the associations of various effects between the two groups. p < 0.05 indicated a statistically significant difference. Thirty patients were included and classified into the CCD( +) and CCD( −) groups (n = 15, each group). Statistics showed that before iPBM, CCD in the CCD( +) group was 2.74 (exp 1.0081) times higher than that of CCD( −) group (p = 0.1632). After iPBM, the CCD was 0.64 (exp-0.4436) times lower in the CCD( +) group than in the CCD( −) group (p < 0.0001). Cognitive assessment revealed that, before iPBM, the CCD( +) group had a non-significantly 0.1030 lower LCF score than that of CCD( −) group (p = 0.1632). Similarly, the CCD( +) group had a non-significantly 0.0013 higher score than that of CCD( −) after iPBM treatment (p = 0.7041), indicating no significant differences between the CCD( +) or CCD( −) following iPBM and general physical therapy. CCD was less likely to appear in iPBM-treated patients. Additionally, iPBM was not associated with LCF score. Administration of iPBM could be applied in TBI patients to reduce the occurrence of CCD. The study failed to show differences in cognitive function after iPBM, which still serves as an alternative non-pharmacological intervention.

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“…[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. To the best of our knowledge, this is the first report to describe increased uptake in the basal ganglia upon presentation of rabbit syndrome.…”

Section: Discussionmentioning

confidence: 99%

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

Chang¹

2018

MOJDDT

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Rabbit syndrome is an extrapyramidal side effect that has been linked with chronic antipsychotic therapy. We report herein a rare case of rabbit syndrome that occurred withoutin administration of a neuroleptics naive patient. A 90-year old female exhibited a perioral tremor movement disorder resembling rabbit syndrome, although she the patient revealed no previous psychiatric history and had never taken antipsychotic medication. Single photon emission computed tomography (SPECT) revealed increased perfusion of the right basal ganglia and left thalamus. Treatment with L-DOPA Madopar faded out resolved the movement disorder, and the second reevaluation by SPECT showed that basal ganglia/thalamus perfusion had returned to baseline. Rabbit syndrome is an extrapyramidal side effect that has been linked with chronic antipsychotic therapy. We present a rare case of rabbit syndrome in a patient naive to antipsychotics that was associated with increased perfusion of the basal ganglia. The underlying cause of the movement disorder and altered perfusion in this case is unknown. However, standard treatment antiparkinsonian treatment for antipsychotic induced rabbit syndrome was effective in this case indicating involvement of the dopaminergic or cholinergic system.

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Postural asymmetry correlated with lateralization of cerebellar perfusion in persons with chronic stroke: A role of crossed cerebellar diaschisis in left side

Abstract: This study indicates that the impairment of posture sway control was more severe in left CCD than the other CCD types. The results support a relationship between the postural asymmetry and lateralization of CCD in patients with chronic stroke.

Cited by 9 publications

References 39 publications

Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the IpsilateralMCATerritory

Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the IpsilateralMCATerritory

Effects of intravascular photobiomodulation on cognitive impairment and crossed cerebellar diaschisis in patients with traumatic brain injury: a longitudinal study

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

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