F-18 FDG PET Demonstrates Crossed Cerebellar Diaschisis 20 Years After Stroke

Shih, Wei-Jen; Hu, Wei; Milan, Primo

doi:10.1097/01.rlu.0000210526.50300.f7

Cited by 19 publications

(11 citation statements)

References 8 publications

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“…However, acquired language impairment is not always associated with obvious focal damage. For example, in cerebellar diachisis, left frontal lesions result in functional changes and tissue loss in right cerebellar regions (Shih et al, 2006). These secondary lesion effects may not be visible by eye, but can be detected using automated methods that detect gray and white matter volumetric changes in high resolution images and the cumulative effects of these structural changes may potentially impact language recovery.…”

Section: Caveats and Future Directionsmentioning

confidence: 99%

Neuroimaging in aphasia treatment research: Quantifying brain lesions after stroke

et al. 2013

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New structural and functional neuroimaging methods continue to rapidly develop, offering promising tools for cognitive neuroscientists. In the last 20 years, advanced magnetic resonance imaging (MRI) techniques have provided invaluable insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Current functional MRI (fMRI) approaches have also allowed researchers to purposefully investigate how individuals recover language after stroke. This paper presents recommendations for quantification of brain lesions derived from discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). Methods for detailing and characterizing the brain damage that can influence results of fMRI studies in chronic aphasic stroke patients are discussed. Moreover, we aimed to provide the reader with a set of general practical guidelines and references to facilitate choosing adequate structural imaging strategies that facilitate fMRI studies in aphasia treatment research.

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Section: Caveats and Future Directionsmentioning

confidence: 99%

Neuroimaging in aphasia treatment research: Quantifying brain lesions after stroke

et al. 2013

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“…14,15 While the original definition of CCD was based on the idea that it is a transient condition, 16 several publications have reported CCD up to decades after the index stroke. [17][18][19][20] Regarding the reversibility of CCD, however, several serial SPECT and PET studies demonstrated that some patients show complete reversal of CCD during follow-up. 11,13,[21][22][23] With respect to functional outcome, the majority of studies in stroke patients using SPECT or PET investigated subacute and chronic CCD, reflecting the fact that these imaging methods are not eligible to routinely assess perfusion in the acute stroke setting.…”

Section: Introductionmentioning

confidence: 99%

Crossed cerebellar diaschisis in acute ischemic stroke: Impact on morphologic and functional outcome

Kunz¹,

Sommer²,

Höhne

et al. 2017

J Cereb Blood Flow Metab

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Crossed cerebellar diaschisis (CCD) is the phenomenon of hypoperfusion and hypometabolism of the contralateral cerebellar hemisphere caused by dysfunction of the related supratentorial region. Our aim was to analyze its influence on morphologic and functional outcome in acute ischemic stroke. Subjects with stroke caused by a large vessel occlusion of the anterior circulation were selected from an initial cohort of 1644 consecutive patients who underwent multiparametric CT including whole-brain CT perfusion. Two experienced readers evaluated the posterior fossa in terms of CCD absence (CCD-) or presence (CCD+). A total of 156 patients formed the study cohort with 102 patients (65.4%) categorized as CCD- and 54 (34.6%) as CCD+. In linear and logistic regression analyses, no significant association between CCD and final infarction volume (β = -0.440, p = 0.972), discharge mRS ≤ 2 (OR = 1.897, p = 0.320), or 90-day mRS ≤ 2 (OR = 0.531, p = 0.492) was detected. CCD+ patients had larger supratentorial cerebral blood flow deficits (median: 164 ml vs. 115 ml; p = 0.001) compared to CCD-patients. Regarding complications, CCD was associated with a higher rate of parenchymal hematomas (OR = 4.793, p = 0.035). In conclusion, CCD is frequently encountered in acute ischemic stroke caused by large vessel occlusion of the anterior circulation. CCD was associated with the occurrence of parenchymal hematoma in the ipsilateral cerebral infarction but did not prove to significantly influence patient outcome.

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“…Brainstem lesions may produce cerebellar diaschisis, 9,10 which may last 20 years after stroke. 11 Although single photon emission computed tomography or positron emission tomography was not done in our patient, we infer that she had cerebellar dysfunction because of diaschisis. Cerebellar dysfunction may decrease human muscle tone and disturb human motor control.…”

Section: Discussionmentioning

confidence: 91%

Preserved motor-evoked potentials but without good motor recovery in a patient with decerebrate rigidity☆

Kao

Lin

Chen

et al. 2011

Journal of the Chinese Medical Association

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The corticospinal tract is not incriminated in decerebrate rigidity (DR). However, this has not yet been proven in humans. We applied transcranial magnetic stimulation (TMS) in a decerebrate patient to support the hypothesis. A patient suffering from pontine hemorrhage with the fourth ventricular extension was admitted unconscious and in a decerebrate posture. Five days later, she regained consciousness but remained in a decerebrate posture. Motor-evoked potentials (MEPs) to TMS were measured 1 week after she had regained consciousness, and this provoked muscle responses in her hands and feet bilaterally. During the follow-up, the patient's muscle tone became persistently flaccid, although her strength increased to varying degrees in different body and limb muscles. She remained bedridden for 3 years after the stroke and could neither turn on the bed by herself nor perform skilled movements using her hands. The findings of TMS confirmed the animal studies in that the mechanism of decerebrate rigidity did not come through a damage of the corticospinal pathway. This also implies that a preserved corticospinal tract function cannot guarantee a good motor recovery in a stroke patient.

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F-18 FDG PET Demonstrates Crossed Cerebellar Diaschisis 20 Years After Stroke

Cited by 19 publications

References 8 publications

Neuroimaging in aphasia treatment research: Quantifying brain lesions after stroke

Neuroimaging in aphasia treatment research: Quantifying brain lesions after stroke

Crossed cerebellar diaschisis in acute ischemic stroke: Impact on morphologic and functional outcome

Preserved motor-evoked potentials but without good motor recovery in a patient with decerebrate rigidity☆

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