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

2020 ◽  
Author(s):  
Martina Sebök ◽  
Christiaan Hendrik Bas Niftrik ◽  
Marco Piccirelli ◽  
Giovanni Muscas ◽  
Athina Pangalu ◽  
...  
Keyword(s):  
Anterior Circulation ◽  
Crossed Cerebellar Diaschisis ◽  
Cerebellar Diaschisis ◽  
Hemodynamic Impairment

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

2017 ◽  
Vol 37 (11) ◽  
pp. 3615-3624 ◽  
Author(s):  
Wolfgang G Kunz ◽  
Wieland H Sommer ◽  
Christopher Höhne ◽  
Matthias P Fabritius ◽  
Felix Schuler ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Large Vessel ◽  
Cerebellar Hemisphere ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Crossed Cerebellar Diaschisis ◽  
Cerebellar Diaschisis

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.

Crossed Cerebellar Diaschisis in Alzheimer’s Disease

2018 ◽  
Vol 15 (13) ◽  
pp. 1267-1275 ◽  
Author(s):  
F.E. Reesink ◽  
D. Vállez García ◽  
C.A. Sánchez-Catasús ◽  
D.E. Peretti ◽  
A.T. Willemsen ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Left Hemisphere ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Pathophysiological Mechanism ◽  
Crossed Cerebellar Diaschisis ◽  
Amyloid Accumulation ◽  
Cerebellar Diaschisis ◽  
18F Fdg

Background: We describe the phenomenon of crossed cerebellar diaschisis (CCD) in four subjects diagnosed with Alzheimer’s disease (AD) according to the National Institute on Aging - Alzheimer Association (NIA-AA) criteria, in combination with 18F-FDG PET and 11C-PiB PET imaging. Methods: 18F-FDG PET showed a pattern of cerebral metabolism with relative decrease most prominent in the frontal-parietal cortex of the left hemisphere and crossed hypometabolism of the right cerebellum. 11C-PiB PET showed symmetrical amyloid accumulation, but a lower relative tracer delivery (a surrogate of relative cerebral blood flow) in the left hemisphere. CCD is the phenomenon of unilateral cerebellar hypometabolism as a remote effect of supratentorial dysfunction of the brain in the contralateral hemisphere. The mechanism implies the involvement of the cortico-ponto-cerebellar fibers. The pathophysiology is thought to have a functional or reversible basis but can also reflect in secondary morphologic change. CCD is a well-recognized phenomenon, since the development of new imaging techniques, although scarcely described in neurodegenerative dementias. Results: To our knowledge this is the first report describing CCD in AD subjects with documentation of both 18F-FDG PET and 11C-PiB PET imaging. CCD in our subjects was explained on a functional basis due to neurodegenerative pathology in the left hemisphere. There was no structural lesion and the symmetric amyloid accumulation did not correspond with the unilateral metabolic impairment. Conclusion: This suggests that CCD might be caused by non-amyloid neurodegeneration. The pathophysiological mechanism, clinical relevance and therapeutic implications of CCD and the role of the cerebellum in AD need further investigation.

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

2015 ◽  
Vol 36 (4) ◽  
pp. 743-754 ◽  
Author(s):  
Wieland H Sommer ◽  
Christine Bollwein ◽  
Kolja M Thierfelder ◽  
Alena Baumann ◽  
Hendrik Janssen ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Symptom Onset ◽  
Ct Perfusion ◽  
Clinical Factors ◽  
Middle Cerebral Artery Infarction ◽  
Whole Brain ◽  
Crossed Cerebellar Diaschisis ◽  
Brain Ct ◽  
Cerebellar Diaschisis

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.

scholarly journals Crossed Cerebellar Diaschisis: Insights into Oxygen Challenge MRI

2012 ◽  
Vol 32 (12) ◽  
pp. 2114-2117 ◽  
Author(s):  
Krishna A Dani ◽  
Celestine Santosh ◽  
David Brennan ◽  
Donald M Hadley ◽  
Keith W Muir
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebral Blood Volume ◽  
Oxygen Extraction Fraction ◽  
Resonance Imaging ◽  
Crossed Cerebellar Diaschisis ◽  
Relative Contribution ◽  
Extraction Fraction ◽  
Signal Change ◽  
Cerebellar Diaschisis ◽  
Weighted Magnetic Resonance Imaging

Hyperoxia during T2∗-weighted magnetic resonance imaging (oxygen challenge imaging (OCI)) causes T2∗-weighted signal change that is dependent on cerebral blood volume (CBV) and oxygen extraction fraction (OEF). Crossed cerebellar diaschisis (CCD), where CBV is reduced but OEF is maintained, may be used to understand the relative contributions of OEF and CBV to OCI results. In subjects with large hemispheric strokes, OCI showed reduced signal change in the contralesional cerebellum ( P = 0.027, n = 12). This was associated with reduced CBV in contralesional cerebellum ( P = 0.039, n = 9). CCD may be a useful model to determine the relative contribution of CBV to signal change measured by OCI.

Crossed Cerebellar Diaschisis

2017 ◽  
pp. 307-308
Author(s):  
Michael J. Hoch ◽  
Ana M. Franceschi ◽  
Timothy M. Shepherd
Keyword(s):  
Crossed Cerebellar Diaschisis ◽  
Cerebellar Diaschisis
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