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Won SY, Melkonian R, Behmanesh B, Bernstock JD, Czabanka M, Dubinski D, Freiman TM, Günther A, Hellmuth K, Hernandez-Duran S, Herrmann E, Konczalla J, Maier I, Mielke D, Naser P, Rohde V, Schaefer JH, Senft C, Storch A, Trnovec S, Unterberg A, Walter J, Walter U, Wittstock M, Dinc N, Gessler F. Cerebellar Stroke Score and Grading Scale for the Prediction of Mortality and Outcomes in Ischemic Cerebellar Stroke. Stroke 2023; 54:2569-2575. [PMID: 37551591 DOI: 10.1161/strokeaha.123.043478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Several individual predictors for outcomes in patients with cerebellar stroke (CS) have been previously identified. There is, however, no established clinical score for CS. Therefore, the aim of this study was to develop simple and accurate grading scales for patients with CS in an effort to better estimate mortality and outcomes. METHODS This multicentric retrospective study included 531 patients with ischemic CS presenting to 5 different academic neurosurgical and neurological departments throughout Germany between 2008 and 2021. Logistic regression analysis was performed to determine independent predictors related to 30-day mortality and unfavorable outcome (modified Rankin Scale score of 4-6). By weighing each parameter via calculation of regression coefficients, an ischemic CS-score and CS-grading scale (CS-GS) were developed and internally validated. RESULTS Independent predictors for 30-day mortality were aged ≥70 years (odds ratio, 5.2), Glasgow Coma Scale score 3 to 4 at admission (odds ratio, 2.6), stroke volume ≥25 cm3 (odds ratio, 2.7), and involvement of the brain stem (odds ratio, 3.9). When integrating each parameter into the CS-score, age≥70 years and brain stem stroke were assigned 2 points, Glasgow Coma Scale score 3 to 4, and stroke volume≥25 cm3 1 point resulting in a score ranging from 0 to 6. CS-score of 0, 1, 2, 3, 4, 5, and 6 points resulted in 30-day mortality of 1%, 6%, 6%, 17%, 21%, 55%, and 67%, respectively. Independent predictors for 30-day unfavorable outcomes consisted of all components of the CS-score with an additional variable focused on comorbidities (CS-GS). Except for Glasgow Coma Scale score 3 to 4 at admission, which was assigned 3 points, all other parameters were assigned 1 point resulting in an overall score ranging from 0 to 7. CS-GS of 0, 1, 2, 3, 4, 5, 6, and 7 points resulted in 30-day unfavorable outcome of 1%, 17%, 33%, 40%, 50%, 80%, 77%, and 100%, respectively. Both 30-day mortality and unfavorable outcomes increased with increasing CS-score and CS-GS (P<0.001). CONCLUSIONS The CS-score and CS-GS are simple and accurate grading scales for the prediction of 30-day mortality and unfavorable outcome in patients with CS. While the score systems proposed here may not directly impact treatment decisions, it may help discuss mortality and outcome with patients and caregivers.
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Affiliation(s)
- Sae-Yeon Won
- Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany
| | - Ruzanna Melkonian
- Department of Neurosurgery (R.M., C.S., N.D.), Jena University Hospital, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.D.B.)
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital, Goethe University Hospital, Frankfurt, Germany (M.C., J.K.)
| | - Daniel Dubinski
- Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany
| | - Thomas M Freiman
- Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany
| | - Albrecht Günther
- Department of Neurology (A.G.), Jena University Hospital, Germany
| | - Kara Hellmuth
- Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany
| | - Silvia Hernandez-Duran
- Department of Neurosurgery, Göttingen University Hospital, Germany (S.H.-D., D.M., V.R.)
| | - Eva Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Hospital, Frankfurt am Main, Germany (E.H.)
| | - Juergen Konczalla
- Department of Neurosurgery, University Hospital, Goethe University Hospital, Frankfurt, Germany (M.C., J.K.)
| | - Ilko Maier
- Department of Neurology, Göttingen University Hospital, Germany (I.M.)
| | - Dorothee Mielke
- Department of Neurosurgery, Göttingen University Hospital, Germany (S.H.-D., D.M., V.R.)
| | - Paul Naser
- Department of Neurosurgery, University of Heidelberg, Germany (P.N., A.U., J.W.)
| | - Veit Rohde
- Department of Neurosurgery, Göttingen University Hospital, Germany (S.H.-D., D.M., V.R.)
| | | | - Christian Senft
- Department of Neurosurgery (R.M., C.S., N.D.), Jena University Hospital, Germany
| | - Alexander Storch
- Department of Neurology (A.S., U.W., M.W.), University Medical Center Rostock, Germany
| | - Svorad Trnovec
- Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Germany (P.N., A.U., J.W.)
| | - Johannes Walter
- Department of Neurosurgery, University of Heidelberg, Germany (P.N., A.U., J.W.)
| | - Uwe Walter
- Department of Neurology (A.S., U.W., M.W.), University Medical Center Rostock, Germany
| | - Matthias Wittstock
- Department of Neurology (A.S., U.W., M.W.), University Medical Center Rostock, Germany
| | - Nazife Dinc
- Department of Neurosurgery (R.M., C.S., N.D.), Jena University Hospital, Germany
| | - Florian Gessler
- Department of Neurosurgery (S.-Y.W., B.B., D.D., T.M.F., K.H., S.T., F.G.), University Medical Center Rostock, Germany
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Huang L, Wang Y, Sun J, Zhu L, Liu J, Wu Y, Shan C, Yan J, Wan P. Incidence and Risk Factors for Dysphagia Following Cerebellar Stroke: a Retrospective Cohort Study. CEREBELLUM (LONDON, ENGLAND) 2023:10.1007/s12311-023-01564-y. [PMID: 37204664 DOI: 10.1007/s12311-023-01564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
The cerebellum is known to play a supportive role in swallowing-related functions; however, wide discrepancies about the incidence rate of swallowing disorders following cerebellar strokes exist within the literature. This study aimed to investigate the incidence rate of dysphagia and the factors which may affect the presence of dysphagia and clinical recovery in individuals diagnosed with cerebellar stroke. A retrospective chart audit of 1651 post-stroke patients (1049 males and 602 females) admitted with a cerebellar stroke to a comprehensive tertiary hospital in China was conducted. Data on demographics, medical, along with swallowing function assessment were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t-tests and Pearson's chi-square test. Univariate logistic regression analysis was performed to establish factors associated with the presence of dysphagia. A total of 11.45% of participants were identified with dysphagia during inpatient admission. Individuals with mixed types of stroke, multiple lesions in the cerebellum, and ages older than 85 years old were more likely to develop dysphagia. Moreover, the prognosis of dysphagia following a cerebellar stroke was associated with lesions in different parts of the cerebellum. The cumulative recovery rates from the best to worse were the right hemisphere group, the cerebellum vermis or peduncle group, and both the hemisphere group and the left hemisphere group, respectively.
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Affiliation(s)
- Li Huang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Yunlu Wang
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Jikang Sun
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Lequn Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Jimin Liu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Yuwei Wu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
| | - Chunlei Shan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Juntao Yan
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Hongkou District, Shanghai, 200437, China
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Ping Wan
- Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China.
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Yao K, Zu HB. Isolated transient vertigo due to TIA: challenge for diagnosis and therapy. J Neurol 2023; 270:769-779. [PMID: 36371598 DOI: 10.1007/s00415-022-11443-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/13/2022]
Abstract
As a prevalent vertigo disease in the clinic, isolated transient vertigo can present as a vertigo episode without focal signs and always free of symptoms on presentation. Previous studies showed a part of isolated transient vertigo events had a high risk of stroke during follow-up. However, how to discern posterior circulation ischemia become a great challenge for clinicians, especially in emergency, neurology, and ENT departments. Routine besides, hematological, and imaging examinations are often difficult provide a clear etiological diagnosis. Hence, this article reviews current knowledge about the epidemiology, risk factors, offending lesions, and clinical manifestation of transient ischemic attack (TIA) presenting as isolated transient vertigo. In addition, we summarize several advances in besides examinations, serum biomarkers, and imaging technologies to better identify stroke events. Finally, the current situation of therapy was briefly retrospected. Here we present a critical clinical puzzle that needs to be solved in the future. Of note, there is a still lack of high-quality studies in this field. The article reviews the keys to the diagnosis of isolated transient vertigo due to TIA and provides us with more methods to screen for high-risk stroke populations.
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Affiliation(s)
- Kai Yao
- Department of Neurology, Jinshan Hospital Affiliated to Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China
| | - Heng-Bing Zu
- Department of Neurology, Jinshan Hospital Affiliated to Fudan University, No. 1508 Longhang Road, Jinshan District, Shanghai, 201508, China.
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Schuhbeck F, Strobl R, Conrad J, Möhwald K, Jaufenthaler P, Jahn K, Dieterich M, Grill E, Zwergal A. Determinants of functioning and health-related quality of life after vestibular stroke. Front Neurol 2022; 13:957283. [PMID: 36158947 PMCID: PMC9492892 DOI: 10.3389/fneur.2022.957283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Stroke accounts for 5–10% of all presentations with acute vertigo and dizziness. The objective of the current study was to examine determinants of long-term functioning and health-related quality of life (HRQoL) in a patient cohort with vestibular stroke. Methods Thirty-six patients (mean age: 66.1 years, 39% female) with an MRI-proven vestibular stroke were followed prospectively (mean time: 30.2 months) in the context of the EMVERT (EMergency VERTigo) cohort study at the Ludwig-Maximilians Universität, Munich. The following scores were obtained once in the acute stage (<24 h of symptom onset) and once during long-term follow-up (preferably >1 year after stroke): European Quality of Life Scale-five dimensions-five levels questionnaire (EQ-5D-5L) and Visual Analog Scale (EQ-VAS) for HRQoL, Dizziness Handicap Inventory (DHI) for symptom severity, and modified Rankin Scale (mRS) for general functioning and disability. Anxiety state and trait were evaluated by STAI-S/STAI-T, and depression was evaluated by the Patient Health Questionnaire-9 (PHQ-9). Voxel-based lesion mapping was applied in normalized MRIs to analyze stroke volume and localization. Multiple linear regression models were calculated to determine predictors of functional outcome (DHI, EQ-VAS at follow-up). Results Mean DHI scores improved significantly from 45.0 in the acute stage to 18.1 at follow-up (p < 0.001), and mean mRS improved from 2.1 to 1.1 (p < 0.001). Mean HRQoL (EQ-5D-5L index/EQ-VAS) changed from 0.69/58.8 to 0.83/65.2 (p = 0.01/p = 0.11). Multiple linear regression models identified higher scores of STAI-T and DHI at the time of acute vestibular stroke and larger stroke volume as significant predictors for higher DHI at follow-up assessment. The effect of STAI-T was additionally enhanced in women. There was a significant effect of patient age on EQ-VAS, but not DHI during follow-up. Conclusion The average functional outcome of strokes with the chief complaint of vertigo and dizziness is favorable. The most relevant predictors for individual outcomes are the personal anxiety trait (especially in combination with the female sex), the initial symptom intensity, and lesion volume. These factors should be considered for therapeutic decisions both in the acute stage of stroke and during subsequent rehabilitation.
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Affiliation(s)
- Franziska Schuhbeck
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Department of Neurology, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Julian Conrad
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Department of Neurology, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Ken Möhwald
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Department of Neurology, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Patricia Jaufenthaler
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Department of Neurology, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Schön Clinic Bad Aibling, Department of Neurology, Bad Aibling, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Department of Neurology, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - Eva Grill
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians Universität Munich, Munich, Germany
- Munich Center for Health Sciences, Ludwig-Maximilians Universität Munich, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- Department of Neurology, LMU Hospital, Ludwig-Maximilians Universität Munich, Munich, Germany
- *Correspondence: Andreas Zwergal
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Abderrakib A, Ligot N, Naeije G. Cerebellar cognitive affective syndrome after acute cerebellar stroke. Front Neurol 2022; 13:906293. [PMID: 36034280 PMCID: PMC9403248 DOI: 10.3389/fneur.2022.906293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The cerebellum modulates both motor and cognitive behaviors, and a cerebellar cognitive affective syndrome (CCAS) was described after a cerebellar stroke in 1998. Yet, a CCAS is seldom sought for, due to a lack of practical screening scales. Therefore, we aimed at assessing both the prevalence of CCAS after cerebellar acute vascular lesion and the yield of the CCAS-Scale (CCAS-S) in an acute stroke setting. Materials and methods All patients admitted between January 2020 and January 2022 with acute onset of a cerebellar ischemic or haemorrhagic first stroke at the CUB-Hôpital Erasme and who could be evaluated by the CCAS-S within a week of symptom onset were included. Results Cerebellar acute vascular lesion occurred in 25/1,580 patients. All patients could complete the CCAS-S. A definite CCAS was evidenced in 21/25 patients. Patients failed 5.2 ± 2.12 items out of 8 and had a mean raw score of 68.2 ± 21.3 (normal values 82–120). Most failed items of the CCAS-S were related to verbal fluency, attention, and working memory. Conclusion A definite CCAS is present in almost all patients with acute cerebellar vascular lesions. CCAS is efficiently assessed by CCAS-S at bedside tests in acute stroke settings. The magnitude of CCAS likely reflects a cerebello-cortical diaschisis.
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Cognitive Dysfunction following Cerebellar Stroke: Insights Gained from Neuropsychological and Neuroimaging Research. Neural Plast 2022; 2022:3148739. [PMID: 35465397 PMCID: PMC9033331 DOI: 10.1155/2022/3148739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 01/26/2023] Open
Abstract
Although the cerebellum has been consistently noted in the process of cognition, the pathophysiology of this link is still under exploration. Cerebellar stroke, in which the lesions are focal and limited, provides an appropriate clinical model disease for studying the role of the cerebellum in the cognitive process. This review article targeting the cerebellar stroke population (1) describes a cognitive impairment profile, (2) identifies the cerebellar structural alterations linked to cognition, and (3) reveals possible mechanisms of cerebellar cognition using functional neuroimaging. The data indicates the disruption of the cerebro-cerebellar loop in cerebellar stroke and its contribution to cognitive dysfunctions. And the characteristic of cognitive deficits are mild, span a broad spectrum, dominated by executive impairment. The consideration of these findings could contribute to deeper and more sophisticated insights into the cognitive function of the cerebellum and might provide a novel approach to cognitive rehabilitation. The goal of this review is to spread awareness of cognitive impairments in cerebellar disorders.
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Erdal Y, Perk S, Keskinkılıc C, Bayramoglu B, Soydan Mahmutoglu A, Emre U. The assessment of cognitive functions in patients with isolated cerebellar infarctions: A follow-up study. Neurosci Lett 2021; 765:136252. [PMID: 34536512 DOI: 10.1016/j.neulet.2021.136252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
The role of the cerebellum on cognitive functions have been well-defined; however, the information related to the progress in time process is limited. In this study, we aimed to evaluate the cognitive function of patients with isolated cerebellar infarction in both the acute stage and the follow-up period. Twenty-three patients with isolated cerebellar infarction and 22 healthy control were examined through an extensive neuropsychological assessment battery. The patients were evaluated in the acute stage and at least six months after the stroke in the follow-up period. There were no significant differences between the patients and the controls regarding age (52.2 ± 7.0 and 54.9 ± 6.6, p = 0.184) and gender (Female/Male: 6/17 and 7/15, p = 0.672). There was no statistically significant difference between patients with right cerebellar infarction and left cerebellar infarction in terms of cognitive functions. Verbal fluency, attention, and verbal and non-verbal episodic memory scores were significantly lower in patient group in the acute stage when compared to the control group. When the follow-up evaluation was compared to acute stage, it was revealed that patients had recovered in all areas; however, less improvement was seen in word reading time. Our results support that lesions of the cerebellum affect cognitive functions in the acute stage. However, the improvement was demonstrated in all cognitive functions in the follow-up period.
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Affiliation(s)
- Yuksel Erdal
- Health Sciences University, Istanbul Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
| | - Seyma Perk
- Health Sciences University, Istanbul Training and Research Hospital, Department of Psychology, Istanbul, Turkey
| | - Cahit Keskinkılıc
- Health Sciences University, Bakırkoy Dr. Mazhar Osman Training and Research Hospital, Department of Neuropsychology, Istanbul, Turkey
| | - Banu Bayramoglu
- Health Sciences University, Bakırkoy Dr. Mazhar Osman Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Abdullah Soydan Mahmutoglu
- Health Sciences University, Istanbul Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ufuk Emre
- Health Sciences University, Istanbul Training and Research Hospital, Department of Neurology, Istanbul, Turkey
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Geva S, Schneider LM, Roberts S, Khan S, Gajardo-Vidal A, Lorca-Puls DL, Team P, Hope TMH, Green DW, Price CJ. Right cerebral motor areas that support accurate speech production following damage to cerebellar speech areas. NEUROIMAGE-CLINICAL 2021; 32:102820. [PMID: 34653836 PMCID: PMC8517928 DOI: 10.1016/j.nicl.2021.102820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
Participants with damage to cerebellar speech regions were studied with fMRI. At the time of test, their speech production was accurate and precise. Their speech production activation was enhanced in right hemisphere motor regions. We provide hypotheses for targeting future fMRI and brain stimulation studies.
Specific regions of the cerebellum are activated when neurologically intact adults speak, and cerebellar damage can impair speech production early after stroke, but how the brain supports accurate speech production years after cerebellar damage remains unknown. We investigated this in patients with cerebellar lesions affecting regions that are normally recruited during speech production. Functional MRI activation in these patients, measured during various single word production tasks, was compared to that of neurologically intact controls, and patient controls with lesions that spared the cerebellar speech production regions. Our analyses revealed that, during a range of speech production tasks, patients with damage to cerebellar speech production regions had greater activation in the right dorsal premotor cortex (r-PMd) and right supplementary motor area (r-SMA) compared to neurologically intact controls. The loci of increased activation in cerebral motor speech areas motivate future studies to delineate the functional contributions of different parts of the speech production network, and test whether non-invasive stimulation to r-PMd and r-SMA facilitates speech recovery after cerebellar stroke.
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Affiliation(s)
- Sharon Geva
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom.
| | - Letitia M Schneider
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom; Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Universitätsring 1, 1010 Vienna, Austria
| | - Sophie Roberts
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom.
| | - Shamima Khan
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom.
| | - Andrea Gajardo-Vidal
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom; Faculty of Health Sciences, Universidad del Desarrollo, Concepcion, Chile.
| | - Diego L Lorca-Puls
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom; Department of Speech, Language and Hearing Sciences, Faculty of Medicine, Universidad de Concepcion, Concepcion, Chile.
| | - Ploras Team
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom
| | - Thomas M H Hope
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom.
| | - David W Green
- Department of Experimental Psychology, Faculty of Brain Sciences, University College London, London, United Kingdom.
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3AR, United Kingdom.
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9
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Geva S, Schneider LM, Roberts S, Green DW, Price CJ. The Effect of Focal Damage to the Right Medial Posterior Cerebellum on Word and Sentence Comprehension and Production. Front Hum Neurosci 2021; 15:664650. [PMID: 34093152 PMCID: PMC8172582 DOI: 10.3389/fnhum.2021.664650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Functional imaging studies of neurologically intact adults have demonstrated that the right posterior cerebellum is activated during verb generation, semantic processing, sentence processing, and verbal fluency. Studies of patients with cerebellar damage converge to show that the cerebellum supports sentence processing and verbal fluency. However, to date there are no patient studies that investigated the specific importance of the right posterior cerebellum in language processing, because: (i) case studies presented patients with lesions affecting the anterior cerebellum (with or without damage to the posterior cerebellum), and (ii) group studies combined patients with lesions to different cerebellar regions, without specifically reporting the effects of right posterior cerebellar damage. Here we investigated whether damage to the right posterior cerebellum is critical for sentence processing and verbal fluency in four patients with focal stroke damage to different parts of the right posterior cerebellum (all involving Crus II, and lobules VII and VIII). We examined detailed lesion location by going beyond common anatomical definitions of cerebellar anatomy (i.e., according to lobules or vascular territory), and employed a recently proposed functional parcellation of the cerebellum. All four patients experienced language difficulties that persisted for at least a month after stroke but three performed in the normal range within a year. In contrast, one patient with more damage to lobule IX than the other patients had profound long-lasting impairments in the comprehension and repetition of sentences, and the production of spoken sentences during picture description. Spoken and written word comprehension and visual recognition memory were also impaired, however, verbal fluency was within the normal range, together with object naming, visual perception and verbal short-term memory. This is the first study to show that focal damage to the right posterior cerebellum leads to language difficulties after stroke; and that processing impairments persisted in the case with most damage to lobule IX. We discuss these results in relation to current theories of cerebellar contribution to language processing. Overall, our study highlights the need for longitudinal studies of language function in patients with focal damage to different cerebellar regions, with functional imaging to understand the mechanisms that support recovery.
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Affiliation(s)
- Sharon Geva
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Letitia M Schneider
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom.,Department of Cognition, Emotion and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Sophie Roberts
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - David W Green
- Department of Experimental Psychology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
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Machner B, Choi JH, Neumann A, Trillenberg P, Helmchen C. What guides decision-making on intravenous thrombolysis in acute vestibular syndrome and suspected ischemic stroke in the posterior circulation? J Neurol 2020; 268:249-264. [PMID: 32772173 PMCID: PMC7815559 DOI: 10.1007/s00415-020-10134-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
Intravenous thrombolysis (IVT) is rarely performed in dizzy patients with acute vestibular syndrome (AVS) or acute imbalance (AIS) even if posterior circulation stroke (PCS) is suspected. Decision-making may be affected by uncertainties in discriminating central from peripheral vestibulopathy or concerns of IVT-related harm, particularly intracerebral hemorrhage (ICH), but related studies are missing. Using an in-house register of dizzy patients coming to the emergency room, we identified 29 AVS/AIS patients who presented within 4.5 h after onset, revealed clinical signs indicative of PCS (central oculomotor signs, mild focal abnormalities), and had non-contrast computed tomography (NCCT). Patients treated with IVT (n = 15) were compared to NoIVT patients (n = 14) with regard to clinical and imaging (including perfusion computed tomography, CTP) parameters, occurrence of ICH and short-term clinical outcome (NIHSS improvement; ability to walk independently). IVT and NoIVT patients did not differ in baseline characteristics, central oculomotor signs, or clinical outcome. IVT patients more often exhibited disabling vestibular symptoms (severe dizziness/vertigo, inability to stand unsupported) and focal abnormalities than NoIVT patients. There was no ICH in either group. CTP was performed in 0% of NoIVT versus 80% of IVT patients, seven of twelve revealing posterior circulation hypoperfusion. Comparison of initial hypoperfusion (CTP) and final stroke (NCCT) revealed IVT-related benefit (smaller lesion) in three of seven IVT patients. In AVS/AIS patients with suspected PCS, disabling vestibular symptoms, focal neurological deficits, and hypoperfusion on CTP seem to direct decision-making pro IVT. In our small cohort, there were no significant IVT-related clinical benefits, no IVT-related ICHs, and salvage of brain tissue in some patients.
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Affiliation(s)
- Björn Machner
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Jin Hee Choi
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Hospitals Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Peter Trillenberg
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christoph Helmchen
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Taskiran-Sag A, Uzuncakmak Uyanik H, Uyanik SA, Oztekin N. Prospective investigation of cerebellar cognitive affective syndrome in a previously non-demented population of acute cerebellar stroke. J Stroke Cerebrovasc Dis 2020; 29:104923. [PMID: 32689613 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE In this prospective study, we aimed to investigate the presence and evolution of cerebellar cognitive affective syndrome in a cohort of isolated cerebellar stroke with no known cognitive or psychiatric impairment. We tried to distinguish the unconfounded effect of cerebellar lesions on neuropsychological processing. METHODS After a meticulous exclusion procedure based on possible confounders, we recruited 14 patients and 13 age-matched healthy controls to the study, prospectively. All of the patients had a detailed initial neuropsychological assessment at the first week and a follow-up assessment at the 4th month after stroke. RESULTS The prevalence of cognitive or behavioral-affective abnormalities in our cohort were 86% and 64% respectively. The patients exhibited mild and transient affective-behavioral abnormalities except for depressive symptoms that persisted in the subacute stage. They scored lower in general cognitive performance as revealed by mini mental test (p=0.001). Memory, executive functions, attention and working memory, central processing speed, and linguistic abilities were impaired (p<0.001; p=0.001; p=0.007; p=0.05; p<0.001 respectively). Improvement was evident only in memory domain of the cognitive functions in the subacute stage. Cognitive impairment was more likely with a medial or posterolateral infarct (p=0.014). Behavioral-affective abnormalities were not associated with a specific location in our cohort. Age seemed to negatively correlate with the recovery in general cognitive performance on the follow-up. CONCLUSIONS These findings show that acute denervation of cerebellocortical projections leads to mild affective-behavioral abnormalities, and full-blown cerebellar cognitive affective syndrome is rare. However, cognition was significantly affected after an acute cerebellar infarct even in a previously healthy, non-demented pure population.
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Affiliation(s)
- Aslihan Taskiran-Sag
- Department of Neurology, Ankara Numune Training and Research Hospital, Sihhiye, 06100 Ankara, Turkey.
| | - Handan Uzuncakmak Uyanik
- Department of Neurology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Sadik Ahmet Uyanik
- Department of Radiology, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Nese Oztekin
- Department of Neurology, Ankara Numune Training and Research Hospital, Sihhiye, 06100 Ankara, Turkey
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