Crossed Cerebellar Diaschisis in Patients With Cortical Infarction

Komaba, Yuichi; Mishina, Masayoshi; Utsumi, Kouichi; Katayama, Yasuo; Kobayashi, Shiro; Mori, Osamu

doi:10.1161/01.str.0000109771.56160.f5

Cited by 73 publications

(33 citation statements)

References 16 publications

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“…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. By screening a large patient collective, we can thus further extend and substantiate the observation that CCD is a common phenomenon after MCA infarction and that WB-CTP provides an appropriate tool to investigate its hemodynamic impact on cerebellar perfusion after cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Sommer¹,

Bollwein²,

Thierfelder³

et al. 2015

J Cereb Blood Flow Metab

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We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Sommer¹,

Bollwein²,

Thierfelder³

et al. 2015

J Cereb Blood Flow Metab

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show abstract

“…The hemispheric locations most likely to cause CCD after infarction appear to include the postcentral and supramarginal areas, 4 but it is unknown how small of a cortical or subcortical infarct might give rise to the phenomenon of CCD.…”

Section: Discussionmentioning

confidence: 99%

Ataxic Hemiparesis From Strategic Frontal White Matter Infarction With Crossed Cerebellar Diaschisis

Flint

Naley

Wright

2006

Stroke

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Background— Ataxic hemiparesis is a classic lacunar syndrome that most often localizes to the pons. Results— We report 3 patients who presented with left-sided ataxic hemiparesis and were found on imaging to have small right frontal subcortical white matter infarcts in similar locations by diffusion-weighted MRI. [ 99m Tc]hexamethylpropylenamine oxime single-photon emission computed tomography (SPECT) scans in all 3 patients showed decreased metabolism in the contralateral cerebellar hemisphere, indicative of crossed cerebellar diaschisis (CCD). Conclusion— CCD is under-recognized in ataxic hemiparesis and may have implications for functional recovery after this type of ischemic stroke.

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“…Crossed cerebellar hypoperfusion (CCH) is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to a supratentorial lesion [7]. This phenomenon can be demonstrated on brain perfusion images obtained by single photon emission computed tomography (SPECT) or by positron emission tomography (PET) [7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Postcarotid Endarterectomy Improvement in Cognition Is Associated with Resolution of Crossed Cerebellar Hypoperfusion and Increase in <sup>123</sup>I-Iomazenil Uptake in the Cerebral Cortex: A SPECT Study

Chida¹,

Ogasawara²,

Aso³

et al. 2010

Cerebrovasc Dis

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Background: The purpose of the present study was to investigate whether resolution of crossed cerebellar hypoperfusion (CCH) and increase in ¹²³I-iomazenil (IMZ) uptake in the ipsilateral cerebral cortex after carotid endarterectomy (CEA) are associated with postoperative improvement of cognitive function. Methods: Neuropsychological testing was performed preoperatively and after 1 postoperative month in 79 patients undergoing CEA for ipsilateral internal carotid artery stenosis (≧70%). Brain perfusion single photon emission computed tomography (SPECT) using N-isopropyl-p-¹²³I-iodoamphetamine and ¹²³I-IMZ SPECT were also performed before and after surgery. Data were analyzed using a three-dimensional stereotaxic region of interest template. Results: Seven patients (9%) showed improvement in postoperative cognitive function. All the 7 patients exhibited both postoperative increase in blood flow in the ipsilateral cerebral cortex and resolution of CCH. Five patients (6%) had a postoperative hemispheric increase in ¹²³I-IMZ uptake, and cognitive function improved in all of these 5 patients. Analysis by a receiver operating characteristic (ROC) curve was used to estimate the ability to discriminate between patients with and without postoperative cognitive improvement. The area under the ROC curve was significantly greater when analyzing the magnitude of postoperative resolution of CCH (0.991; 95% CI 0.984–1.001) or postoperative hemispheric increase in ¹²³I-IMZ uptake (0.981; 95% CI 0.972–0.999) when compared with the magnitude of postoperative increase in cerebral blood flow (0.929; 95% CI 0.886–0.971) (p < 0.05). Conclusions: Resolution of CCH and increase in ¹²³I-IMZ uptake in the ipsilateral cerebral cortex after CEA is associated with postoperative improvement in cognitive function. These results may indicate that cognitive impairment is related to a state of potentially reversible central benzodiazepine receptor downregulation in the cortex in response to transient ischemic attack or minor stroke.

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Crossed Cerebellar Diaschisis in Patients With Cortical Infarction

Cited by 73 publications

References 16 publications

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

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

Ataxic Hemiparesis From Strategic Frontal White Matter Infarction With Crossed Cerebellar Diaschisis

Postcarotid Endarterectomy Improvement in Cognition Is Associated with Resolution of Crossed Cerebellar Hypoperfusion and Increase in <sup>123</sup>I-Iomazenil Uptake in the Cerebral Cortex: A SPECT Study

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