Implied functional crossed cerebello-cerebral diaschisis and interhemispheric compensation during hand grasping more than 20 years after unilateral cerebellar injury in early childhood

Abstract

BackgroundCrossed cerebello-cerebral diaschisis (CCCD) conventionally refers to decreased resting cerebral activity caused by injury to the contralateral cerebellum. We investigated whether functional activation of a contralesional cerebral cortical region controlling a specific task is reduced during task performance in a patient with a unilateral cerebellar lesion. We also examined functional compensation by the corresponding ipsilesional cerebral cortex. It was hypothesized that dysfunction of the primary sensorimotor cortex (SM1) contralateral to the cerebellar lesion would be detected together with a compensatory increase in neural activity of the ipsilesional SM1. To test these possibilities, we conducted non-invasive functional neuroimaging techniques for bilateral SM1 during hand grasping, a task known to activate predominantly the SM1 contralateral to the grasping hand. Activity in SM1 during hand grasping was measured electrophysiologically by magnetoencephalography and hemodynamically by near-infrared spectroscopy in an adult with mild right hemiataxia associated with a large injury of the right cerebellum due to resection of a tumor in early childhood.ResultsDuring left hand grasping, increased neural activity was detected predominantly in the right SM1, the typical developmental pattern. In contrast, neural activity increased in the bilateral SM1 with slight right-side dominance during right (ataxic) hand grasping.ConclusionsThis study reported a case that implied functional CCCD and compensatory neural activity in the SM1 during performance of a simple hand motor task in an adult with unilateral cerebellar injury and mild hemiataxia 24 years prior to the study without rehabilitative interventions. This suggests that unilateral cerebellar injuries in early childhood may result in persistent functional abnormalities in the cerebrum into adulthood. Therapeutic treatments that target functional CCCD and interhemispheric compensation might be effective for treating ataxia due to unilateral cerebellar damage.

Functional Outcomes of Cerebellar Malformations

“…In fact, one of the earliest radiographic examples of diaschisis was found in the cerebellum with an entity described as crossed cerebellar diaschisis, in which hypometabolism is observed in cerebellar hemispheres contralateral to a supratentorial lesion (Baron et al, 1981). Since that time, clinical correlation to this phenomenon has been made including a case report in which there was persistent alterations in cerebellar activity after contralateral basal ganglia infarct (Di Piero et al, 1990), a case series showing that in 20% of patients with thalamic infarct there was associated hypoperfusion of the contralateral cerebellum (Förster et al, 2014), and finally an intriguing case report in which a childhood lesion of the cerebellum corresponded to alterations in contralateral cortical hemispheric function that was compensated by the ipsilateral cortex during performance of a motor task (Nakahachi et al, 2015). The concept of diaschisis is inextricably linked to the concept of distributed network formation, or inter-regional connectivity.…”

Frontal activation patterns during Tetris game play and differences between high and low performers: a preliminary functional near-infrared spectroscopy study

“…Instructions were given orally. We previously succeeded in detecting activation patterns during cognitive and motor tasks by using this procedure with the ETG-4000 (Nakahachi et al2008(Nakahachi et al , 2010(Nakahachi et al , 2015(Nakahachi et al , 2016 was analyzed at temporal resolution of 100 msec using this fNIRS (ETG-4000) because [oxy-Hb] is considered to be most sensitive to changes in rCBV, and it strongly correlates with the BOLD signal of fMRI, while the direction of [deoxy-Hb] changes is influenced by changes in blood oxygenation and volume of the vein (Hoshi et al 2001(Hoshi et al , 2003Scarapicchia et al 2017). The analysis software of ETG-4000 was set at the "integral mode".…”