Crossed Cerebellar Diaschisis in Acute Isolated Thalamic Infarction Detected by Dynamic Susceptibility Contrast Perfusion MRI

Abstract

PurposeCrossed cerebellar diaschisis (CCD) is a state of neural depression caused by loss of connections to injured neural structures remote from the cerebellum usually evaluated by positron emission tomography. Recently it has been shown that dynamic susceptibility contrast perfusion weighted MRI (PWI) may also be feasible to detect the phenomenon. In this study we aimed to assess the frequency of CCD on PWI in patients with acute thalamic infarction.MethodsFrom a MRI report database we identified patients with acute isolated thalamic infarction. Contralateral cerebellar hypoperfusion was identified by inspection of time to peak (TTP) maps and evaluated quantitatively on TTP, mean transit time (MTT), cerebral blood flow and volume (CBF, CBV) maps. A competing cerebellar pathology or an underlying vascular pathology were excluded.ResultsA total of 39 patients was included. Common symptoms were hemiparesis (53.8%), hemihypaesthesia (38.5%), dysarthria (30.8%), aphasia (17.9%), and ataxia (15.4%). In 9 patients (23.1%) PWI showed hypoperfusion in the contralateral cerebellar hemisphere. All of these had lesions in the territory of the tuberothalamic, paramedian, or inferolateral arteries. Dysarthria was observed more frequently in patients with CCD (6/9 vs. 6/30; OR 8.00; 95%CI 1.54–41.64, p = 0.01). In patients with CCD, the median ischemic lesion volume on DWI (0.91 cm3, IQR 0.49–1.54 cm3) was larger compared to patients with unremarkable PWI (0.51 cm3, IQR 0.32–0.74, p = 0.05). The most pronounced changes were found in CBF (0.94±0.11) and MTT (1.06±0.13) signal ratios, followed by TTP (1.05±0.02).ConclusionsMultimodal MRI demonstrates CCD in about 20% of acute isolated thalamic infarction patients. Lesion size seems to be a relevant factor in its pathophysiology.

Crossed cerebellar diaschisis after stroke identified noninvasively with cerebral blood flow-weighted arterial spin labeling MRI

“…Although CCD has been shown to correlate with reduced fractional anisotropy along the corticospinal tract, results from one prior study correlating CCD from PET with fMRI were consistent with our results, finding not all subjects with CCD following chronic strokes have Wallerian degeneration [21]. While CCD has most commonly been associated with infarcts in areas involving the corticospinal tract, relationships between CCD and non-motor regions such as the thalamus [22], temporal association cortex and limbic system [23] have also been demonstrated [22]. In a study examining CCD with SPECT, Komaba Y, et al [24] identified only the postcentral and supramarginal gyrus as independent determinants of CCD after controlling for confounding effects.…”

Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics

“…13,14,22,[25][26][27] The results of these studies, however, were predominantly obtained by analyses of small study populations (range: 18-113) 13,14,17,22,25,26,28 and/or by inclusion of various vascular territories 1,13,25,[27][28][29] and by inclusion of acute and chronic infarcts. 26,27 The strokes we investigated, however, were acute strokes restricted to the MCA territory to avoid a dispersion of the results by inclusion of different infarct stages and vascular territories.…”

“…Moreover, we enrolled a large patient cohort which exceeded the size of study populations investigated in terms of CCD so far (mean: 51.1; range: 18-113). 13,14,17,22,25,26,28,52 Still, we cannot fully rule out the possibility of having underestimated the frequency of CCD as we counted only those cases as CCD positive, that show hemodynamic alterations suggestive of CCD in at least two perfusion parameter maps. However, artifacts on single perfusion maps can often be observed in CT imaging of the posterior fossa and this approach helped to limit the number of false-positive findings.…”

Value of Dynamic Susceptibility Contrast Perfusion MRI in the Acute Phase of Transient Global Amnesia

“…Nevertheless, there are only a few reports on the application of DSC perfusion-weighted MRI (PWI) in TGA and all of these reported negative results [ 4 – 6 ]. However, meanwhile a substantial number of studies have been published addressing the detection of subtle perfusion abnormalities by use of PWI in different neurological disorders like migraine with aura [ 7 , 8 ], or crossed cerebellar diaschisis [ 9 , 10 ], an epiphenomenon in acute ischemic stroke.…”