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Smalling S, Roberts J, Hendrick K, Gray M, Wyrwa JM. Vestibular Testing and Impairments in Postoperative Pediatric Cerebellar Mutism Syndrome: A Case Series. Pediatr Neurol 2024; 154:15-19. [PMID: 38447508 DOI: 10.1016/j.pediatrneurol.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Postoperative pediatric cerebellar mutism syndrome (CMS) may occur following a process affecting the posterior cranial fossa. Recent evidence demonstrates disabling and potentially lasting motor components of this syndrome, including ataxia, hemiparesis, and oculomotor dysfunction. These impairments may contribute to vestibular deficits. METHODS This case series contributes data to quantify vestibular dysfunction in postoperative CMS. The pair consisted of one female and one male. RESULTS Vestibular testing demonstrated both peripheral and central dysfunction. CONCLUSIONS Given these findings, a thorough vestibular assessment may be indicated as part of a comprehensive evaluation following a postoperative CMS diagnosis. Further research is needed to understand the pathophysiology, treatment, and long-term outcomes of postoperative pediatric CMS.
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Affiliation(s)
- Stephanie Smalling
- Department of Physical Therapy, Children's Hospital Colorado, Aurora, Colorado
| | - Jeremy Roberts
- Department of Physical Medicine & Rehabilitation, Department of Pediatric Rehabilitation, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
| | - Karen Hendrick
- Department of Audiology, Children's Hospital Colorado, Aurora, Colorado
| | - Margot Gray
- Department of Physical Therapy, Children's Hospital Colorado, Aurora, Colorado
| | - Jordan M Wyrwa
- Department of Physical Medicine & Rehabilitation, Department of Pediatric Rehabilitation, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
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Bush S, Klimo P, Onar-Thomas A, Huang J, Boop FA, Gajjar A, Robinson GW, Khan RB. Application of the Rotterdam postoperative cerebellar mutism syndrome prediction model in patients undergoing surgery for medulloblastoma in a single institution. J Neurosurg Pediatr 2024; 33:174-178. [PMID: 38000061 PMCID: PMC10810679 DOI: 10.3171/2023.9.peds23160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/25/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Postoperative cerebellar mutism syndrome (CMS) develops in up to 40% of children with medulloblastoma. The Rotterdam model (RM) has been reported to predict a 66% risk of CMS in patients with a score of ≥ 100. The aim of this study was to retrospectively apply the RM to an independent cohort of patients with newly diagnosed medulloblastoma and study the applicability of the RM in predicting postoperative CMS. METHODS Participants had to have their first tumor resection at the authors' institution and be enrolled in the SJMB12 protocol (NCT01878617). All participants underwent structured serial neurological evaluations before and then periodically after completing radiation therapy. Imaging was reviewed by the study neurologist who was blinded to CMS status when reviewing the scans and retrospectively applied RM score to each participant. RESULTS Forty participants were included (14 females and 26 males). Four (10%) patients had CMS. The median age at tumor resection was 11.7 years (range 3.5-17.8 years). Tumor location was midline in 30 (75%), right lateral in 6 (15%), and left lateral in 4 (10%). The median Evans index was 0.3 (range 0.2-0.4), and 34 (85%) patients had an Evans index ≥ 0.3. Five participants required a ventricular shunt. The median tumor volume was 51.97 cm3 (range 20.13-180.58 cm3). Gross-total resection was achieved in 35 (87.5%) patients, near-total resection in 4 (10%), and subtotal in 1. The median RM score was 90 (range 25-145). Eighteen participants had an RM score of ≥ 100, and of these 16.7% (n = 3) had CMS. Of the 22 patients with an RM score < 100, 1 child developed CMS (4.5%, CI 0.1%-22.8%); 3 of the 18 patients with an RM score ≥ 100 developed CMS (16.7%, CI 3.6%-41.4%). The observed rate of CMS in the cohort of children with an RM score ≥ 100 was significantly lower than the observed rate in the original RM cohort (66.7%, CI 51%-80.0%, p < 0.001). A greater risk of CMS in patients with an RM score ≥ 100 could not be confirmed (p = 0.31). CONCLUSIONS At the authors' institution, the incidence of CMS in patients who had an RM ≥ 100 was significantly lower than the RM cohort. These findings raise questions regarding generalizability of RM; however, fewer cases of CMS and a relatively small cohort limit this conclusion.
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Affiliation(s)
- Savannah Bush
- University of Tennessee, School of Medicine, Memphis
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee, Memphis
| | | | | | | | | | | | - Raja B. Khan
- Division of Neurology, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Nigam M, Harrison DS, Bhattacharyya S. Zebra sign in cerebellar haemorrhage after craniotomy. BMJ Case Rep 2023; 16:e256736. [PMID: 38081740 PMCID: PMC10728916 DOI: 10.1136/bcr-2023-256736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Minali Nigam
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Steven Harrison
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shamik Bhattacharyya
- Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Wahane M, Kaushal H, Goyal G, Sarna M. An atypical case of hypomagnesemia-induced cerebellar syndrome with literature review. J R Coll Physicians Edinb 2023; 53:272-277. [PMID: 37936278 DOI: 10.1177/14782715231209776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Cerebellar ataxia in adults is always a diagnostic challenge. One of the important causes of late-onset cerebellar ataxia is hypomagnesemia. Hypomagnesemia can have varied manifestations and is attributable to numerous causes. Identification of hypomagnesemia-induced cerebellar syndrome (HiCS) is important as it is reversible but often missed. HiCS has distinct clinical findings and characteristic magnetic resonance imaging (MRI) findings. HiCS presents with distinct clinical, biochemical, and neuroimaging findings, but it cannot be ruled out even in the absence of neuroimaging findings. This condition has to be treated promptly and meticulously to avoid precipitating any serious complications, and a strong suspicion is required for the diagnosis. The underlying cause should be evaluated and managed, as HiCS is a serious but potentially reversible disease with a good prognosis. We present a case of HiCS presenting with a characteristic history of recurrent ataxia, tremor, and vertigo that improved with treatment. Our patient was atypical, as there were no significant MRI findings attributable to hypomagnesemia. Only seven case reports are available throughout the world that show such disparity.
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Affiliation(s)
- Madhugandha Wahane
- Department of Neurology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - Himanshu Kaushal
- Department of Neurology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - Gaurav Goyal
- Department of Neurology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India
| | - Mukesh Sarna
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, Rajasthan, India
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Wu C, Wang J, Zhang L, Yan F, Yang Z, He L, Guo J. Effect of massive cerebellar infarction on the outcomes of patients with acute basilar artery occlusion during hospitalization after endovascular treatment: A retrospective study. Medicine (Baltimore) 2023; 102:e34154. [PMID: 37478217 PMCID: PMC10662876 DOI: 10.1097/md.0000000000034154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/09/2023] [Indexed: 07/23/2023] Open
Abstract
Acute basilar artery occlusion (ABAO) after endovascular treatment (EVT) is often associated with a poor prognosis, particularly in patients with cerebellar infarction who may develop malignant cerebellar edema. The present study aimed to investigate how massive cerebellar infarction (MCI) affects hospitalization outcomes in ABVO patients who undergo EVT. We conducted a retrospective study of ABVO patients who underwent EVT at our hospital between September 2017 and September 2022. MCI was diagnosed using imaging techniques, and various prognostic scores were assessed during hospitalization to examine the relationship between MCI and these outcomes. We identified 42 ABAO patients, of whom 22 (52.4%) had MCI. Patients with MCI had a higher modified Rankin Scale (mRS) score at discharge compared to those without MCI (4.36 ± 1.14 vs 3.05 ± 1.85, P = .042, odds ratio [OR] (95% confidence interval [CI]) = 1.093 (0.083, 2.103)), and a lower Glasgow Coma Scale score (6.59 ± 4.0 vs 10.10 ± 5.07, P = .036, OR (95% CI) = -3.444 (-6.518, -0.369)). MCI was identified as an independent risk factor for an extremely poor prognosis (mRS ≥ 5) at discharge (P = .036, OR (95% CI) = 15.531 (1.603, 313.026)) and for no improvement in mRS score compared to onset (P = .013, OR (95% CI) = 0.025 (0.001, 0.274)). Additionally, an extremely poor prognosis was independently associated with stent implantation, EVT duration, and body mass index, while mRS score improvement was correlated with EVT duration and pulmonary infection. MCI in ABAO patients is a significant independent risk factor for a poor prognosis at discharge and no improvement in function score compared to onset. Early diagnosis and intervention are necessary to improve outcomes, particularly in high-risk populations.
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Affiliation(s)
- Chuyue Wu
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jing Wang
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Lina Zhang
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Fei Yan
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Zhenjie Yang
- Department of Radiology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Lei He
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Jing Guo
- Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- School of Medicine, Chongqing University, Chongqing, P.R. China
- Chongqing Municipality Clinical Research Center for Geriatric diseases, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, P.R. China
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Shibamiya N, Yamauchi M, Kuratomi Y, Komune S. Cerebellar Abscess Induced by Cochlear Fistula due to Chronic Suppurative Otitis Media. ORL J Otorhinolaryngol Relat Spec 2023; 85:238-242. [PMID: 37423215 DOI: 10.1159/000531252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
Cochlear fistulas with cholesteatoma as the primary disease have been reported frequently in the relevant literature. However, there are no reports of cochlear fistula without cholesteatoma due to chronic suppurative otitis media with intracranial complications. We report a case of cochlear fistula due to chronic otitis media that was diagnosed after the onset of a cerebellar abscess. The patient was a 25-year-old man with severe autism. He was admitted to our hospital with otorrhea from his left ear, emesis, and impaired consciousness. Computed tomography (CT) of the head showed left suppurative otitis media, left cerebellar abscess, and brainstem compression due to hydrocephalus. Right extra-ventricular drainage and brain abscess drainage were urgently performed. The next day, foramen magnum decompression and abscess drainage with partial resection of the swollen cerebellum were performed for decompression purposes. He was subsequently treated with antimicrobial therapy, but magnetic resonance imaging of the head showed an increase in the size of the cerebellar abscess. Re-examination of the temporal bone CT scans revealed a bony defect in the left cochlear promontory angle. We assumed that the cochlear fistula was responsible for the otogenic brain abscess. Thus, the patient underwent surgical closure of the cochlear fistula. After the operation, the cerebellar abscess lesion gradually shrank, and his general condition stabilized. Cochlear fistula should be considered in the management of patients with inflammatory middle ear disease associated with otogenic intracranial complications in the middle ear.
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Affiliation(s)
- Natsuko Shibamiya
- Department of Otolaryngology-Head and Neck Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Moriyasu Yamauchi
- Department of Otolaryngology-Head and Neck Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Yuichiro Kuratomi
- Department of Otolaryngology-Head and Neck Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Shizuo Komune
- Division of Otolaryngology-Head and Neck Surgery, Yuaikai Oda Hospital, Kashima, Japan
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Zhao J, Luo B, Yao X, Zhang X, He D, Cai L, Xu Y, Li Q, Wan Z. Cerebellar infarction caused by vertebral artery dissection: A case report. Medicine (Baltimore) 2023; 102:e34033. [PMID: 37327265 PMCID: PMC10270511 DOI: 10.1097/md.0000000000034033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
RATIONALE Vertebral artery dissection is an important cause of posterior circulation ischemic stroke in young and middle-aged people. We reported a young man with cerebellar infarction caused by dissection of the right vertebral artery. PATIENT CONCERNS A 34-year-old man presented with intermittent dizziness, blurred vision, nausea, and transient tinnitus 10 days before admission. All these symptoms were gradually aggravated and followed by vomiting and unfavorable movement of the right limbs. All these symptoms gradually aggravated. DIAGNOSIS Neurological examination on admission showed ataxia of the right limbs. Magnetic resonance imaging of the head revealed a right cerebellar infarction. High-resolution vessel wall magnetic resonance imaging showed dissection of the right vertebral artery. Whole-brain CT digital subtraction angiography revealed occlusion of the third segment (V3) of the right vertebral artery. This supports the diagnosis of vertebral artery dissection. INTERVENTIONS The patient received anticoagulant treatment with warfarin. OUTCOMES After 2 weeks of treatment, the patient showed remarkably alleviated dizziness and unfavorable movement of the right limbs. After 3 months of treatment, the modified Rankin Scale score was 0. MRI of the head revealed that the original right cerebellar focus was softened, and there were no newly formed infarct foci. LESSONS When young and middle-aged patients without atherosclerotic risk factors encounter sudden dizziness, tinnitus, and unfavorable limb movement, vertebral artery dissection may be considered. Careful inquiry into the medical history may help make a final diagnosis. Further high-resolution vessel wall magnetic resonance imaging is an effective means to find arterial dissection. Early diagnosis and treatment for vertebral artery dissection has a favorable prognosis.
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Affiliation(s)
- Jing Zhao
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Bin Luo
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Xinlu Yao
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Xiaoyun Zhang
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Daquan He
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Lina Cai
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Yahui Xu
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Qin Li
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
| | - Zhirong Wan
- Department of Neurology, Aerospace Center Hospital, Beijing 100049, China
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Yang W, Li Y, Ying Z, Cai Y, Peng X, Sun H, Chen J, Zhu K, Hu G, Peng Y, Ge M. A presurgical voxel-wise predictive model for cerebellar mutism syndrome in children with posterior fossa tumors. Neuroimage Clin 2023; 37:103291. [PMID: 36527996 PMCID: PMC9791171 DOI: 10.1016/j.nicl.2022.103291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed to investigate cerebellar mutism syndrome (CMS)-related voxels and build a voxel-wise predictive model for CMS. METHODS From July 2013 to January 2022, 188 pediatric patients diagnosed with posterior fossa tumor were included in this study, including 38 from a prospective cohort recruited between 2020 and January 2022, and the remaining from a retrospective cohort recruited in July 2013-Aug 2020. The retrospective cohort was divided into the training and validation sets; the prospective cohort served as a prospective validation set. Voxel-based lesion symptoms were assessed to identify voxels related to CMS, and a predictive model was constructed and tested in the validation and prospective validation sets. RESULTS No significant differences were detected among these three data sets in CMS rate, gender, age, tumor size, tumor consistency, presence of hydrocephalus and paraventricular edema. Voxels related to CMS were mainly located in bilateral superior and inferior cerebellar peduncles and the superior part of the cerebellum. The areas under the curves for the model in the training, validation and prospective validation sets were 0.889, 0.784 and 0.791, respectively. CONCLUSIONS Superior and inferior cerebellar peduncles and the superior part of the cerebellum were related to CMS, especially the right side, and voxel-based lesion-symptom analysis could provide valuable predictive information before surgery.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zesheng Ying
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - HaiLang Sun
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jiashu Chen
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Kaiyi Zhu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 030032, China
| | - Geli Hu
- Department of Clinical and Technical Support, Philips Healthcare, Beijing 100600, China
| | - Yun Peng
- Department of Image Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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Yang W, Zhang H, Cai Y, Peng X, Sun H, Chen J, Ying Z, Zhu K, Peng Y, Ge M. Postoperative MRI features of cerebellar mutism syndrome: a retrospective cohort study. J Neurosurg Pediatr 2022; 30:567-577. [PMID: 36208442 DOI: 10.3171/2022.8.peds22294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to investigate the relationship between postoperative MRI features and cerebellar mutism syndrome. METHODS A retrospective cohort of patients who underwent tumor resection from July 2013 to March 2021 for midline posterior fossa tumors was investigated. All patients were followed up at least once. Clinical data were extracted from medical records and follow-up databases. Two neuroradiologists independently reviewed preoperative and postoperative MRI. Univariable and multivariable analyses were performed to compare the postoperative cerebellar mutism syndrome (pCMS) and non-pCMS groups. Correlation analysis was performed using the Spearman correlation coefficient analysis. RESULTS Of 124 patients, 47 (37.9%) developed pCMS. The median follow-up duration was 45.73 (Q1: 33.4, Q3: 64.0) months. The median duration of mutism was 45 days. The median tumor size was 48.8 (Q1: 42.1, Q3: 56.8) mm. In the univariable analysis, abnormal T2-weighted signal of the left dentate nucleus (DN) (74.5% in the pCMS group vs 36.4% in the non-pCMS group, p < 0.001), right DN (83.0% vs 40.3%, p < 0.001), left superior cerebellar peduncle (SCP) (74.5% vs 27.3%, p < 0.001), right SCP (63.8% vs 23.4%, p < 0.001), left middle cerebellar peduncle (MCP) (51.1% vs 26.0%, p = 0.008), and right MCP (61.7% vs 26.0%, p < 0.001); male sex (83.0% vs 45.5%, p < 0.001); vermis 3 impairment (49.4% vs 19.1%, p = 0.002); solid tumor (91.5% vs 72.7%, p = 0.022); and hydrocephalus (72.3% vs 45.5%, p = 0.006) were more frequent in the pCMS group than in the non-pCMS group. Multivariable logistic analysis showed that male sex (adjusted OR 4.08, p = 0.010) and the cerebro-cerebellar circuit score of T2-weighted images (adjusted OR 2.15, p < 0.001) were independent risk factors for pCMS. The cerebro-cerebellar circuit score positively correlated with the duration of mutism. In Cox regression analysis, the cerebro-cerebellar integrated circuit injury score of T2 (adjusted HR 0.790, 95% CI 0.637-0.980; p = 0.032) and injury of vermis 3 (adjusted HR 3.005, 95% CI 1.197-7.547; p = 0.019) were independently associated with the duration of mutism. CONCLUSIONS Male sex and cerebro-cerebellar circuit damage are independent risk factors for pCMS. The cerebro-cerebellar circuit score indicates the duration of mutism.
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Affiliation(s)
- Wei Yang
- 1Departments of Neurosurgery and
| | - Hong Zhang
- 2Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | | | | | | | | | | | - Kaiyi Zhu
- 3Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan; and
- 4Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Peng
- 2Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing
| | - Ming Ge
- 1Departments of Neurosurgery and
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Yang YD, Li DZ. Recurrent Fetal Cerebellar Hemorrhage: Think Homozygous Protein C Deficiency. J Pediatr Hematol Oncol 2021; 43:e1256-e1258. [PMID: 33902063 DOI: 10.1097/mph.0000000000002184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yan-Dong Yang
- Ultrasound Department, The Sixth Affiliated Hospital of Sun Yat-sen University
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center Guangdong, China
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Richter D, Hegelmaier T, Schneider-Gold C, Gold R, Faissner S. Delayed Diagnosis of Anti-Hu Antibodies in a Young Patient With Cerebellar Atrophy. Pediatr Neurol 2020; 111:27-29. [PMID: 32951652 DOI: 10.1016/j.pediatrneurol.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Daniel Richter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Hegelmaier
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Simon Faissner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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Alhayek K, Aldabbour B, Refa'I HAR, Alanbar M. Wernekink Commissure Syndrome: A Rare Cause of Bilateral Cerebellar Syndrome. Acta Neurol Taiwan 2020; 29(3):86-89. [PMID: 32996116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Focal signs are a big deal in neurology and are among the most important clues leading to diagnosis and localization. Wernekink commissure syndrome is due to lesions in the caudal paramedian midbrain involving the entire decussation of the superior cerebellar peduncles, resulting in the clinical hallmark of a bilateral cerebellar syndrome. CASE REPORT A 79-year-old man presented with sudden, severe unsteadiness associated with slurring of speech, binocular double vision, and bilateral hand tremor. Examination showed right INO, moderately severe dysarthria, bilateral dysmetria and dysdiadochokinesia, with severe truncal ataxia and bilateral upper and lower limb ataxia. Also, bilateral coarse tremor was noted in both hands which was present at rest, action and on reaching for objects. Brain MRI revealed an acute infarction involving the Wernekinck decussation in the right caudal midbrain and mesencephalo-pontine junction. CONCLUSION The differential of Wernekink Commissure Syndrome is complex, and localization and lateralization are extremely difficult owing to prominent bilateral cerebellar symptoms. The finding of an associated unilateral INO in some cases makes it possible to confidently narrow the list of differentials and localize the lesion to the paramedian tegmentum ipsilateral to the non-adducting eye.
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Affiliation(s)
- Kefah Alhayek
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Belal Aldabbour
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Haneen Al Refa'I Refa'I
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Maram Alanbar
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
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13
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Paquier PF, Walsh KS, Docking KM, Hartley H, Kumar R, Catsman-Berrevoets CE. Post-operative cerebellar mutism syndrome: rehabilitation issues. Childs Nerv Syst 2020; 36:1215-1222. [PMID: 31222445 PMCID: PMC7250945 DOI: 10.1007/s00381-019-04229-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Tumors of the cerebellum are the most common brain tumors in children. Modern treatment and aggressive surgery have improved the overall survival. Consequently, growing numbers of survivors are at high risk for developing adverse and long-term neurological deficits including deficits of cognition, behavior, speech, and language. Post-operative cerebellar mutism syndrome (pCMS) is a well-known and frequently occurring complication of cerebellar tumor surgery in children. In the acute stage, children with pCMS may show deterioration of cerebellar motor function as well as pyramidal and cranial neuropathies. Most debilitating is the mutism or the severe reduction of speech and a range of neurobehavioral symptoms that may occur. In the long term, children that recover from pCMS continue to have more motor, behavioral, and cognitive problems than children who did not develop pCMS after cerebellar tumor surgery. The severity of these long-term sequelae seems to be related to the length of the mute phase. AIM OF THIS NARRATIVE REVIEW The impact of pCMS on patients and families cannot be overstated. This contribution aims to discuss the present knowledge on the natural course, recovery, and rehabilitation of children with pCMS. We suggest future priorities in developing rehabilitation programs in order to improve the long-term quality of life and participation of children after cerebellar tumor surgery and after pCMS in particular.
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Affiliation(s)
- Philippe F Paquier
- Department of Neuropsychology, University Hospital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Clinical and Experimental Neurolinguistics, Center for Linguistics (CLIN), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Unit of Translational Neurosciences, School of Medicine and Health Sciences, Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Karin S Walsh
- Division of Pediatric Neuropsychology, Children's National Health System, Departments of Pediatrics and Psychiatry, The George Washington University Medical Center, Washington DC, USA
| | - Kimberley M Docking
- Discipline of Speech Pathology, University of Sydney, and Sydney Children's Hospital Network, Sydney, Australia
| | - Helen Hartley
- Department of Physiotherapy, Alder Hey Children's Hospital, Liverpool, UK
| | - Ram Kumar
- Department of Paediatric Neurology, Alder Hey Children's Hospital, Liverpool, UK
| | - Coriene E Catsman-Berrevoets
- Department of Pediatric Neurology, Erasmus University Hospital/ Sophia Children's Hospital, Postbox 2040, 3000 CA, Rotterdam, The Netherlands.
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14
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Abstract
BACKGROUND Post-operative paediatric cerebellar mutism syndrome is a well-recognized complication following posterior fossa tumour resection in children. Over the past few decades, imaging has played an important role in understanding this disorder. AIM This review article aims to focus on the disorder from a radiological perspective, summarizing the salient radiological evidence related to the anatomical structures, pathophysiology, and risk factors related to this disorder. CONCLUSION Radiological studies have been integral to the improved understanding of this condition. Future large multicentre studies and quantitative analysis techniques will be vital in further refinement of our understanding of this complex condition.
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Affiliation(s)
- Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, East Prescot Road, Liverpool, L14 5AB, UK.
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15
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Schmahmann JD. Pediatric post-operative cerebellar mutism syndrome, cerebellar cognitive affective syndrome, and posterior fossa syndrome: historical review and proposed resolution to guide future study. Childs Nerv Syst 2020; 36:1205-1214. [PMID: 31240391 PMCID: PMC7020253 DOI: 10.1007/s00381-019-04253-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cerebellar mutism (CM), pseudobulbar palsy, posterior fossa syndrome (PFS), and cerebellar cognitive affective syndrome (CCAS) are terms that have been used, sometimes interchangeably, to refer to the complex neurological constellation that occurs following surgical removal of cerebellar and fourth ventricular tumors, mostly in children, but also sometimes in adults. METHODS This paper reviews the origins of what is now regarded as pediatric post-operative cerebellar mutism, the cerebellar cognitive affective syndrome, and the neurological manifestations of injury to or disruption of brainstem and cerebellar structures. It examines the specific components of each of these phenomena in the context of the evolving understanding of the role of the cerebellum in nervous system function. RESULTS Children undergoing surgical management of tumors in the posterior cranial fossa are at risk of experiencing cranial neuropathies, corticospinal damage, cerebellar ataxia and related motor disorders, neuropsychiatric and cognitive changes, and in some patients, mutism. These clinical presentations are differentiated from each other and examined in the context of the relevant anatomical structures and distributed neural circuits. The term posterior fossa syndrome is not sufficiently helpful in distinguishing the different elements of the clinical phenomena from each other, and because of this lack of precision and specificity, there is consensus among investigators in the international Posterior Fossa Society that the designation be retired. CONCLUSIONS Using contemporary brain imaging methods and guided by careful clinical observation and meticulous definition of clinical phenomenology, it is now feasible to perform detailed structure function correlation analyses to achieve two critical goals in the care of children with tumors in the posterior cranial fossa. The first goal is to identify and understand the neural circuits responsible for the different manifestations-arousal, cranial neuropathies, long tract signs, cerebellar motor syndrome, cerebellar vestibular syndrome, cerebellar cognitive affective syndrome including emotional dyscontrol, and mutism. The second goal is to transform this knowledge into practical clinical intervention, preventing the complications inherent in the necessary surgery whenever possible, and develop new approaches to treatment with methods including brain modulation targeting interconnected nodes of the damaged neural circuits.
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Affiliation(s)
- Jeremy D Schmahmann
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
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16
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DE Brito MH, Grativvol RS, Lucato LT, Pinto LF. Reverse crossed cerebellar diaschisis in status epilepticus: case report. Arq Neuropsiquiatr 2020; 78:182. [PMID: 32236330 DOI: 10.1590/0004-282x20190175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/16/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Marcelo Houat DE Brito
- Departamento de Neurologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Leandro Tavares Lucato
- Departamento de Radiologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lécio Figueira Pinto
- Departamento de Neurologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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17
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Ju H, Lee M, Im K, Kim YH, Kwon KY. A case of acute cerebellar ataxia with two possible etiologies: viral cerebellitis and paraneoplastic antibody-positive ovarian cancer. Neurol Sci 2020; 41:2285-2287. [PMID: 32112217 DOI: 10.1007/s10072-020-04308-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hyunjin Ju
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Mina Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Kayeong Im
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Yon Hee Kim
- Department of Pathology, Soonchunhyang University Medical College, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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18
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Abstract
Cerebellar abiotrophy (CA) is a neurodegenerative disorder affecting the cerebellum and occurs in multiple species. Although CA is well researched in humans and mice, domestic species such as the dog, cat, sheep, cow, and horse receive little recognition. This may be due to few studies addressing the mechanism of CA in these species. However, valuable information can still be extracted from these cases. A review of the clinicohistologic phenotype of CA in these species and determining the various etiologies of CA may aid in determining conserved and required pathways necessary for proper cerebellar development and function. This review outlines research approaches of studies of CA in domestic species, compared to the approaches used in mice, with the objective of comparing CA in domestic species while identifying areas for further research efforts.
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Affiliation(s)
- Erica Yuki Scott
- Department of Animal Science, University of California, Davis, Meyer Hall, 1 Shields Ave, Davis, CA, 95616, USA
| | - Kevin Douglas Woolard
- Department of Pathology, Microbiology & Immunology, University of California, Davis, Davis, CA, USA
| | - Carrie J Finno
- Department of Population Health and Reproduction, University of California, Davis, Davis, CA, USA
| | - James D Murray
- Department of Animal Science, University of California, Davis, Meyer Hall, 1 Shields Ave, Davis, CA, 95616, USA.
- Department of Population Health and Reproduction, University of California, Davis, Davis, CA, USA.
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19
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Cerasa A, Arcuri F, Pignataro LM, Serra S, Messina D, Carozzo S, Biafora A, Ceraudo C, Abbruzzino L, Pignolo L, Basta G, Tonin P. The cooking therapy for cognitive rehabilitation of cerebellar damage: A case report and a review of the literature. J Clin Neurosci 2018; 59:357-361. [PMID: 30337124 DOI: 10.1016/j.jocn.2018.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND IMPORTANCE The therapeutic approach for cerebellar damages heavily relies on neurorehabilitation since there are no medications that may improve clinical symptoms mainly those related to cognitive dysfunctions. Nevertheless, neurorehabilitation programs tailored to cerebellar damages have never been validated. Here we describe a new rehabilitation approach based on cooking training (CT). The idea that cooking may stimulate cerebellar activity relies on previous evidence demonstrating the beneficial effect on the executive functions as well as in promoting neural plasticity within the cerebellum. Indeed, CT requires motor/mental coordination, thinking flexibly, planning, implementing strategies, shifting and self-monitoring behaviors, all functions drastically affected in cerebellar disorders. CASE DESCRIPTION A 68-year-old male stroke patient with isolated right cerebellar ischemia in the posterior cerebellum characterized by mild executive dysfunctions. After intensive six weekly two-hour sessions, we found that CT was effective in improving some cognitive abilities in a context of mild motor impairment. In particular, deficits in the execution of the Symbol digit modality test and Wisconsin card-sorting test were recovered. CONCLUSION The comparison of our data with those reported in previous studies confirmed the Schmahmann's hypothesis on the effectiveness of neurorehabilitation approaches in cerebellar patients acting as external timekeeping of conscious thoughts.
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Affiliation(s)
- Antonio Cerasa
- IBFM, National Research Council, 88100 Catanzaro, Italy; S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy.
| | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | | | | | - Demetrio Messina
- Department of Neurology, "S. Giovanni di Dio" Hospital, Largo Bologna, 88900 Crotone, Italy
| | - Simone Carozzo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | - Antonio Biafora
- Cooking Soon Association, Loc. Garga 9 San Giovanni in Fiore, 87055 Cosenza, Italy
| | - Caterina Ceraudo
- Cooking Soon Association, Loc. Garga 9 San Giovanni in Fiore, 87055 Cosenza, Italy
| | - Luca Abbruzzino
- Cooking Soon Association, Loc. Garga 9 San Giovanni in Fiore, 87055 Cosenza, Italy
| | - Loris Pignolo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | - Giuseppina Basta
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900 Crotone, Italy
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20
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Ceschin R, Zahner A, Reynolds W, Gaesser J, Zuccoli G, Lo CW, Gopalakrishnan V, Panigrahy A. A computational framework for the detection of subcortical brain dysmaturation in neonatal MRI using 3D Convolutional Neural Networks. Neuroimage 2018; 178:183-197. [PMID: 29793060 PMCID: PMC6503677 DOI: 10.1016/j.neuroimage.2018.05.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/04/2018] [Accepted: 05/19/2018] [Indexed: 12/16/2022] Open
Abstract
Deep neural networks are increasingly being used in both supervised learning for classification tasks and unsupervised learning to derive complex patterns from the input data. However, the successful implementation of deep neural networks using neuroimaging datasets requires adequate sample size for training and well-defined signal intensity based structural differentiation. There is a lack of effective automated diagnostic tools for the reliable detection of brain dysmaturation in the neonatal period, related to small sample size and complex undifferentiated brain structures, despite both translational research and clinical importance. Volumetric information alone is insufficient for diagnosis. In this study, we developed a computational framework for the automated classification of brain dysmaturation from neonatal MRI, by combining a specific deep neural network implementation with neonatal structural brain segmentation as a method for both clinical pattern recognition and data-driven inference into the underlying structural morphology. We implemented three-dimensional convolution neural networks (3D-CNNs) to specifically classify dysplastic cerebelli, a subset of surface-based subcortical brain dysmaturation, in term infants born with congenital heart disease. We obtained a 0.985 ± 0. 0241-classification accuracy of subtle cerebellar dysplasia in CHD using 10-fold cross-validation. Furthermore, the hidden layer activations and class activation maps depicted regional vulnerability of the superior surface of the cerebellum, (composed of mostly the posterior lobe and the midline vermis), in regards to differentiating the dysplastic process from normal tissue. The posterior lobe and the midline vermis provide regional differentiation that is relevant to not only to the clinical diagnosis of cerebellar dysplasia, but also genetic mechanisms and neurodevelopmental outcome correlates. These findings not only contribute to the detection and classification of a subset of neonatal brain dysmaturation, but also provide insight to the pathogenesis of cerebellar dysplasia in CHD. In addition, this is one of the first examples of the application of deep learning to a neuroimaging dataset, in which the hidden layer activation revealed diagnostically and biologically relevant features about the clinical pathogenesis. The code developed for this project is open source, published under the BSD License, and designed to be generalizable to applications both within and beyond neonatal brain imaging.
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Affiliation(s)
- Rafael Ceschin
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
| | - Alexandria Zahner
- Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - William Reynolds
- Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Jenna Gaesser
- Division of Neurology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Giulio Zuccoli
- Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Cecilia W Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vanathi Gopalakrishnan
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashok Panigrahy
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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21
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Peterson RR, Kuruvilla A. Seizures and Cerebellar Calcification in a Child with Autoimmune Polyendocrine Syndrome 3A. Indian Pediatr 2018; 55:527-528. [PMID: 29978826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Rachel Ranitha Peterson
- Department of Pediatrics, Bangalore Baptist Hospital Bellary Road, Hebbal, Bengaluru, Karnataka, India.
| | - Asha Kuruvilla
- Department of Radiology, Bangalore Baptist Hospital Bellary Road, Hebbal, Bengaluru, Karnataka, India
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22
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Rao RS, Sheshadri S, Bhattacharjee D, Patil N, Rao K. Progressive Non-familial Adult onset Cerebellar Degeneration: An Unusual Occurrence with Hashimoto's Thyroiditis. Psychopharmacol Bull 2018; 48:42-46. [PMID: 29713105 PMCID: PMC5875367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Progressive non-familial adult onset cerebellar degeneration has been rarely associated with hypothyroidism and is known to be reversible after therapy. We report a case of cerebellar atrophy in a 31 year old female whose detailed evaluation had revealed sub-clinical hypothyroidism secondary to autoimmune thyroiditis with a very high anti-TPO (anti-thyroid peroxidase) antibody levels. MRI (Magnetic Resonanace Imaging) of brain showed diffuse bilateral cerebellar atrophy. She was treated with thyroid hormone supplementation and after one year of follow up, cerebellar signs had disappeared completely with significant reduction in anti-TPO antibody levels. Imaging of the brain post one year of follow-up revealed normal cerebellum. Hence, we opine that thyroid dysfunction should always be kept in mind while evaluating patients presenting with acute onset cerebellar ataxia as it can be easily reversed with thyroid hormone replacement therapy.
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Affiliation(s)
- Raghavendra S Rao
- Drs. Rao, Sheshadri, Rao, (Internal Medicine), Department of Internal Medicine, Kasturba Medical College, MAHE, Manipal, India. Drs. Bhattacharjee, Patil, (Pharmacology), Department of Pharmacology, Kasturba Medical College, MAHE, Manipal, India
| | - Shubha Sheshadri
- Drs. Rao, Sheshadri, Rao, (Internal Medicine), Department of Internal Medicine, Kasturba Medical College, MAHE, Manipal, India. Drs. Bhattacharjee, Patil, (Pharmacology), Department of Pharmacology, Kasturba Medical College, MAHE, Manipal, India
| | - Dipanjan Bhattacharjee
- Drs. Rao, Sheshadri, Rao, (Internal Medicine), Department of Internal Medicine, Kasturba Medical College, MAHE, Manipal, India. Drs. Bhattacharjee, Patil, (Pharmacology), Department of Pharmacology, Kasturba Medical College, MAHE, Manipal, India
| | - Navin Patil
- Drs. Rao, Sheshadri, Rao, (Internal Medicine), Department of Internal Medicine, Kasturba Medical College, MAHE, Manipal, India. Drs. Bhattacharjee, Patil, (Pharmacology), Department of Pharmacology, Kasturba Medical College, MAHE, Manipal, India
| | - Karthik Rao
- Drs. Rao, Sheshadri, Rao, (Internal Medicine), Department of Internal Medicine, Kasturba Medical College, MAHE, Manipal, India. Drs. Bhattacharjee, Patil, (Pharmacology), Department of Pharmacology, Kasturba Medical College, MAHE, Manipal, India
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23
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Abstract
This chapter summarizes the neuropathologic features of nonneoplastic disorders of the adult cerebellum. Gait ataxia and extremity dysmetria are clinical manifestations of diseases that interrupt the complex cerebellar circuitry between the neurons of the cerebellar cortex, the cerebellar nuclei (especially the dentate nuclei), and the inferior olivary nuclei. The cerebellum is a prominent target of several sporadic and hereditary neurodegenerative diseases, including multiple system atrophy, spinocerebellar ataxia, and Friedreich ataxia. Purkinje cells display selective vulnerability to hypoxia but a surprising resistance to hypoglycemia. A classic toxin that damages the cerebellar cortex is methylmercury, but the most common injurious agent to Purkinje cells is ethanol. Many drugs cause ataxia, but doubts continue about phenytoin. Ischemic lesions of the cerebellum due to arterial thrombosis or embolism cause a spectrum of symptoms and signs, depending on the territory involved. Large hemorrhages have an unfavorable prognosis because they displace critical brainstem structures or penetrate into the fourth ventricle. Fungal infections and toxoplasmosis of the cerebellum, and cerebellar progressive multifocal leukoencephalopathy, have become rarer because of improved control of the acquired immunodeficiency syndrome. Ataxia is a prominent feature of prion disease. Adult-onset Niemann-Pick type C1 disease and Kufs disease may have a predominantly ataxic clinical phenotype. The adult cerebellum is also vulnerable to several leukodystrophies. A rare but widely recognized complication of cancer is paraneoplastic cerebellar degeneration.
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Affiliation(s)
- Arnulf H Koeppen
- Research, Neurology, and Pathology Services, Veterans Affairs Medical Center and Departments of Neurology and Pathology, Albany Medical College, Albany, NY, United States.
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24
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Uccelli A, Gattorno M. Neurological manifestations in autoinflammatory diseases. Clin Exp Rheumatol 2018; 36 Suppl 110:61-67. [PMID: 29742058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/07/2017] [Indexed: 06/08/2023]
Abstract
Autoinflammatory diseases (AIDs) are a distinct group of diseases characterised by a dysregulation of the innate immune response leading to systemic inflammation. The clinical spectrum of these conditions is extremely variable and possibly every system and tissue can be involved, including the central nervous system (CNS). Indeed, neurological manifestations may dominate the clinical picture from disease onset in some rare conditions. However, the involvement of the CNS in AIDs is not a disease in itself, but represents a rare complication which is consequent to a systemic or local immune response, mainly involving cells of the innate immunity. This review will describe neurological manifestations associated with AIDs, including: chronic aseptic meningitis and brain atrophy, sensori-neural hearing loss, early-onset haemorrhagic and ischaemic strokes, mental retardation, cerebellitis, and ataxia, and severe encephalopathy with brain calcifications.
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Affiliation(s)
- Antonio Uccelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa; Ospedale Policlinico San Martino, IRCCS, Genoa; and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
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25
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Shimoda Y, Ohtomo S, Arai H, Ohtoh T, Tominaga T. Subarachnoid small vein occlusion due to inflammatory fibrosis-a possible mechanism for cerebellar infarction in cryptococcal meningoencephalitis: a case report. BMC Neurol 2017; 17:157. [PMID: 28793877 PMCID: PMC5551018 DOI: 10.1186/s12883-017-0934-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cryptococcal meningoencephalitis (CM) causes cerebral infarction, typically, lacunar infarction in the basal ganglia. However, massive cerebral infarction leading to death is rare and its pathophysiology is unclear. We report a case of CM causing massive cerebellar infarction, which led to cerebral herniation and death. CASE PRESENTATION A 56-year-old man who suffered from dizziness and gait disturbance for one month was admitted to our hospital and subsequently diagnosed with a cerebellar infarction. He had a past medical history of hepatitis type B virus infection and hepatic failure. Although the findings on magnetic resonance imaging (MRI) imitated an arterial infarction of the posterior inferior cerebellar artery, an accompanying irregular peripheral edema was observed. The ischemic lesion progressed, subsequently exerting a mass effect and leading to impaired consciousness. External and internal decompression surgeries were performed. Cryptococcus neoformans was confirmed in the surgical specimen, and the patient was diagnosed with CM. In addition, venule congestion in the parenchyma was observed with extensive fibrosis and compressed veins in the subarachnoid space. The patient died 26 days after admission. Autopsy revealed that pathological changes were localized in the cerebellum. CONCLUSION C. neoformans can induce extensive fibrosis of the subarachnoid space, which may compress small veins mechanically inducing venule congestion and massive cerebral infarction. In such cases, the clinical course can be severe and even rapidly fatal. An atypical pattern of infarction on MRI should alert clinicians to the possibility of C. neoformans infection.
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Affiliation(s)
- Yoshiteru Shimoda
- Department of Neurosurgery, South Miyagi Medical Center, 38-1 Azanishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253 Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoru Ohtomo
- Department of Neurosurgery, South Miyagi Medical Center, 38-1 Azanishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253 Japan
| | - Hiroaki Arai
- Department of Neurosurgery, South Miyagi Medical Center, 38-1 Azanishi, Ogawara-machi, Shibata-gun, Miyagi 989-1253 Japan
| | - Takashi Ohtoh
- Department of Pathology, South Miyagi Medical Center, Shibata-gun, Miyagi Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Iyengar S, Chambers CJ, Millsop JW, Fung MA, Sharon VR. Purple patches in an immunocompromised patient: a report of secondary disseminated cutaneous mucormycosis in a man with chronic lymphocytic leukemia. Dermatol Online J 2017; 23:13030/qt8cm6m764. [PMID: 28329517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 06/06/2023] Open
Abstract
A 60-year-old man with chronic lymphocytic leukemiadeveloped a deeply violaceous annular patchwith a halo of erythema on the right thigh duringhospitalization for neutropenic fever. Associatedsymptoms included chronic cough and fatigue.Bilateral lung opacities with hilar lymphadenopathywere noted on chest computed tomographyscan. Punch biopsy and tissue culture confirmeda diagnosis of secondary disseminated cutaneousmucormycosis. Although rare, physicians shouldinclude mucormycosis in the differential diagnosisof purpuric patches in immunosuppressed patients.Prompt skin biopsy and tissue culture may optimizethe success of treatment.
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Affiliation(s)
| | | | | | | | - Victoria R Sharon
- Department of Dermatology, Hofstra Northwell School of Medicine, New Hyde Park, New York
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Farahna M, Seke Etet PF, Osman SY, Yurt KK, Amir N, Vecchio L, Aydin I, Aldebasi YH, Sheikh A, Chijuka JC, Kaplan S, Adem A. Garcinia kola aqueous suspension prevents cerebellar neurodegeneration in long-term diabetic rat - a type 1 diabetes mellitus model. J Ethnopharmacol 2017; 195:159-165. [PMID: 27825990 DOI: 10.1016/j.jep.2016.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 08/04/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The development of compounds able to improve metabolic syndrome and mitigate complications caused by inappropriate glycemic control in type 1 diabetes mellitus is challenging. The medicinal plant with established hypoglycemic properties Garcinia kola Heckel might have the potential to mitigate diabetes mellitus metabolic syndrome and complications. AIM OF THE STUDY We have investigated the neuroprotective properties of a suspension of G. kola seeds in long-term type 1 diabetes mellitus rat model. MATERIALS AND METHODS Wistar rats, made diabetic by single injection of streptozotocin were monitored for 8 months. Then, they were administered with distilled water or G. kola oral aqueous suspension daily for 30 days. Body weight and glycemia were determined before and after treatment. After sacrifice, cerebella were dissected out and processed for stereological quantification of Purkinje cells. Histopathological and immunohistochemical analyses of markers of neuroinflammation and neurodegeneration were performed. RESULTS Purkinje cell counts were significantly increased, and histopathological signs of apoptosis and neuroinflammation decreased, in diabetic animals treated with G. kola compared to diabetic rats given distilled water. Glycemia was also markedly improved and body weight restored to non-diabetic control values, following G. kola treatment. CONCLUSIONS These results suggest that G. kola treatment improved the general condition of long-term diabetic rats and protected Purkinje cells partly by improving the systemic glycemia and mitigating neuroinflammation.
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Affiliation(s)
- Mohammed Farahna
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia.
| | - Paul F Seke Etet
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Sayed Y Osman
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia; Department of Biochemistry and Molecular Biology, Faculty of Science and Technology, Al-Neelain University, Khartoum, Sudan
| | - Kıymet K Yurt
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Naheed Amir
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - Lorella Vecchio
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Isınsu Aydin
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Yousef H Aldebasi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Azimullah Sheikh
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - John C Chijuka
- Department of Optometry, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
| | - Süleyman Kaplan
- Department of Histology and Embryology, Medical Faculty, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Abdu Adem
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE.
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Abstract
RATIONALE Remote cerebellar hemorrhage (RCH) is a rare complication of supratentorial and spinal surgeries, seldom requiring intervention but occasionally causing significant morbidity or even mortality. Although a number of theories have been proposed, the exact pathophysiology of RCH remains incompletely understood. PATIENT CONCERNS We present a 62-year-old patient with RCH encountered following surgical clipping of an unruptured middle cerebral artery bifurcation aneurysm in a patient with previous cerebellar infarction. LESSONS It is extremely rare, but sometimes, RCH can be life-threatening. It is necessary to check the patient's general condition, underlying diseases and medical history. And controlled drainage of the CSF seems to be most important. Arachnoidplasty may be a consideration and the position of the drain string might have to be carefully determined.
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Abstract
RATIONALE Crossed cerebellar diaschisis (CCD) is a poor prognostic factor after stroke because without immediate cerebral reperfusion no further improvements in the patient's condition can be achieved. We investigated the clinical effects of intravascular laser irradiation therapy (ILIB) on CCD and evaluated the therapeutic effect in the sub-acute post-stroke stage. PATIENT CONCERNS The 77-year-old male with cerebral infarction in the territory of the right anterior cerebral artery only underwent conservative treatment including hydration and aspirin in the acute post-stroke stage. DIAGNOSIS He was diagnosed as stroke based on the clinical presentations and imaging findings. INTERVENTION Once the patient was in stable condition, he underwent a daily hour-long ILIB (He-Ne laser) for ten consecutive days during the sub-acute post-stroke stage. OUTCOMES We used single-photon emission computed tomography (SPECT) before and after intravascular laser irradiation to detect changes in cerebral and cerebellar perfusion. Then, we compared the two images. CCD was detected using the first SPECT. After intervention by ILIB, the second SPECT showed greater perfusion in the affected cerebellar hemisphere. LESSONS We found that ILIB helped eliminate CCD, which was previously shown to be an untreatable condition using any intervention during the sub-acute post-stroke stage. Stroke patients could therefore greatly benefit from ILIB.
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Stoodley CJ, MacMore JP, Makris N, Sherman JC, Schmahmann JD. Location of lesion determines motor vs. cognitive consequences in patients with cerebellar stroke. Neuroimage Clin 2016; 12:765-775. [PMID: 27812503 PMCID: PMC5079414 DOI: 10.1016/j.nicl.2016.10.013] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/29/2016] [Accepted: 10/14/2016] [Indexed: 11/21/2022]
Abstract
Cerebellar lesions can cause motor deficits and/or the cerebellar cognitive affective syndrome (CCAS; Schmahmann's syndrome). We used voxel-based lesion-symptom mapping to test the hypothesis that the cerebellar motor syndrome results from anterior lobe damage whereas lesions in the posterolateral cerebellum produce the CCAS. Eighteen patients with isolated cerebellar stroke (13 males, 5 females; 20-66 years old) were evaluated using measures of ataxia and neurocognitive ability. Patients showed a wide range of motor and cognitive performance, from normal to severely impaired; individual deficits varied according to lesion location within the cerebellum. Patients with damage to cerebellar lobules III-VI had worse ataxia scores: as predicted, the cerebellar motor syndrome resulted from lesions involving the anterior cerebellum. Poorer performance on fine motor tasks was associated primarily with strokes affecting the anterior lobe extending into lobule VI, with right-handed finger tapping and peg-placement associated with damage to the right cerebellum, and left-handed finger tapping associated with left cerebellar damage. Patients with the CCAS in the absence of cerebellar motor syndrome had damage to posterior lobe regions, with lesions leading to significantly poorer scores on language (e.g. right Crus I and II extending through IX), spatial (bilateral Crus I, Crus II, and right lobule VIII), and executive function measures (lobules VII-VIII). These data reveal clinically significant functional regions underpinning movement and cognition in the cerebellum, with a broad anterior-posterior distinction. Motor and cognitive outcomes following cerebellar damage appear to reflect the disruption of different cerebro-cerebellar motor and cognitive loops.
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Affiliation(s)
- Catherine J. Stoodley
- Department of Psychology and Center for Behavioral Neuroscience, American University, Washington, DC, USA
| | - Jason P. MacMore
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Nikos Makris
- Center for Morphometric Analysis, Departments of Psychiatry and Neurology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Janet C. Sherman
- Psychology Assessment Center, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy D. Schmahmann
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Abstract
A typical case of Fahr's syndrome is described in a 76-year-old Brazilian female who underwent a total thyroidectomy three decades ago. Six years before the current admission, she started with generalized tonic-clonic seizures. Associated disorders involved extra-pyramidal, cognitive, nocturnal terror and mood changes. With suspicion of hypocalcemia due to secondary hypoparathyroidism, laboratory determinations confirmed the diagnoses. Furthermore, imaging studies of the central nervous system detected multiple calcifications, with characteristic distribution of Fahr's syndrome. Clinical management was successful.
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Verdes JM, Moraña A, Gutiérrez F, Battes D, Fidalgo LE, Guerrero F. Cerebellar Degeneration in Cattle Grazing Solanum Bonariense (“Naranjillo”) in Western Uruguay. J Vet Diagn Invest 2016; 18:299-303. [PMID: 16789723 DOI: 10.1177/104063870601800314] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cattle in western Uruguay that were eating Solanum bonariense developed periodic episodes of ataxia, hypermetria, hyperesthesia, head and thoracic limb extension, opisthotonus, nystagmus, and falling to the side or backward. Similar clinical signs were experimentally reproduced in cattle by administration of S. bonariense via rumen cannula at a dose of 1,024 g/kg body mass. No significant gross lesions were observed in field cases or experimentally induced cases. Spontaneous and induced histologic lesions were similar and included vacuolation, degeneration, and loss of Purkinje cells. Axonal spheroids, microcavitations, and other changes of wallerian-type degeneration in cerebellar white matter were also observed. Ultrastructural changes included increased number of electron-dense residual storage bodies in membrane-bound vesicles in affected Purkinje cells, and similar vesicles and mitochondria in axonal spheroids. No histologic lesions were detected in the other examined tissues. The Purkinje-cell swelling and vacuolation with subsequent cerebellar degeneration are suggestive of Purkinje-cell specific toxin that produces abnormal lysosome function and cell specific axonal transport. This is the first report of S. bonariense toxicity.
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Affiliation(s)
- José Manuel Verdes
- Department of Molecular and Cellular Biology, Veterinary Faculty, Universidad de la República Oriental del Uruguay
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Abstract
Crossed cerebellar diaschisis (CCD) describes a depression of oxidative metabolism glucose and blood flow in the cerebellum secondary to a supratentorial lesion in the contralateral cerebral hemisphere. PET/MR has the potential to become a powerful tool for demonstrating and imaging intracranial lesions .We herein report 3 cases of CCD imaging using a tri-modality PET/CT-MR set-up for investigating the value of adding MRI rather than CT to PET in clinical routine.We describe 3 patients with CCD and neurological symptoms in conjunction with abnormal cerebral fluorodeoxyglucose (FDG) positron emission tomography/computed tomography-magnetic resonance imaging (PET/CT-MR) manifestations including arterial spin-labeling (ASL) and T2-weighted images. In all, 18FDG-PET/CT detected positive FDG uptake in supratentorial lesions, and hypometabolism with atrophy in the contralateral cerebellum. More than that, hybrid PET/MRI provided a more accurate anatomic localization and ASL indicated disruption of the cortico-ponto-cerebellar pathway.Using pathology or long-term clinical follow-up to confirm the PET and ASL findings, the supratentorial lesions of the 3 patients were respectively diagnosed with cerebral infarction, recurrent glioma, and metastasis.The reports emphasize the significance of multimodality radiological examinations. Multimodality imaging contributes to proper diagnosis, management, and follow-up of supratentorial lesions with CCD.
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Affiliation(s)
- Shuguang Han
- From the Department of Radiology and the Department of Neurology (SH, KX, CH), Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, PR China (XW)
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Abstract
BACKGROUND Stroke is a decidedly devastating event for any patient, but particularly for a military aviator in a single-seat aircraft. Incidence of acute ischemic infarct in men ages 25 to 29 ranges from 3.4 to 5.6/100,000. The neurological sequelae of stroke can have a lasting and profound impact on an aviator's career. Literature review revealed a relatively small number of cases where stroke was attributable to cervical manipulation. CASE REPORT A 29-yr-old male jet pilot with a 2-wk history of cervicalgia following a mountain bike ride performed self-manipulation of his neck at home following a visit to a chiropractor. He sustained an immediate onset of euphoria, nausea, dysarthria, vertigo, diploplia, and occipital headache, and was transported via ambulance to the nearest emergency department. The patient's MRI/MRA imaging revealed a dissection of his right vertebral artery, as well as bilateral cerebellar infarcts. During the course of the following months, the patient's residual symptoms included neck pain, headaches, disequilibrium, and quadrantanopia. DISCUSSION The ability to recognize the symptoms of stroke and seek treatment in a timely manner are paramount and can drastically reduce the potential for permanent deficit. The evaluation of residual sequelae in military aviators who fly single-seat aircraft is of particular interest to aerospace medicine physicians when it comes time to return a pilot to flight duties. Additionally, the link between cervical manipulation and vertebral artery dissection leading to stroke remains equivocal, and further research is warranted.
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Affiliation(s)
- Maya Dattatraya Bhat
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, 560029, India
| | - K N Vykuntaraju
- Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Ullas V Acharya
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, 560029, India
| | - Premlatha Ramaswamy
- Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, 560029, India.
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Chang RSK, Leung CYW, Leong HS. Bilateral Striatopallidodentate Calcinosis associated with Systemic Lupus Erythematosus: Case report and review of literature. J Neurol Sci 2015; 358:518-9. [PMID: 26440422 DOI: 10.1016/j.jns.2015.09.373] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Richard Shek-kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region.
| | - Chun-Yin William Leung
- Li KaShing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region
| | - Ho Shu Leong
- Division of Neurology, Department of Medicine, Li KaShing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region
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Avula S, Mallucci C, Kumar R, Pizer B. Posterior fossa syndrome following brain tumour resection: review of pathophysiology and a new hypothesis on its pathogenesis. Childs Nerv Syst 2015; 31:1859-67. [PMID: 26351235 DOI: 10.1007/s00381-015-2797-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/19/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Posterior fossa syndrome (PFS), also known as cerebellar mutism syndrome (CMS), is a severe complication affecting children following surgery for posterior fossa brain tumours. Its incidence varies between 8 and 31 %, and its exact pathogenesis remains unclear. In this article, we aim to review the existing theories on its pathogenesis and propose a new hypothesis. DISCUSSION There is varying level of evidence on existing theories on the pathogenesis of PFS following surgery. These include cerebellar perfusion deficits due to vasospasm, oedema or axonal injury due to direct surgical injury and neuronal dysfunction. There is emerging evidence that interruption of the dentato-thalamo-cortical (DTC) pathway is responsible for PFS. Based on our experience with intraoperative MRI, radiological and pathological evidence on heat-related brain injury, we propose a new hypothesis implicating thermal injury resulting from the use of the Cavitron Ultrasonic Aspirator (CUSA) as an important mechanism in the pathogenesis of PFS. CONCLUSION The pathogenesis of PFS is likely to be multifactorial with direct injury from surgery being a major factor. We believe that thermal injury in addition to mechanical injury to the proximal segment of the DTC plays an important role in the pathogenesis of PFS and should be considered in future research related to the aetiology, prevention and management of PFS.
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Affiliation(s)
- Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ram Kumar
- Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Meriglier E, Debouverie O, Walter-Lepage A, Brigaud A, Beuvon C, Luca L. [Primary Sjögren's syndrome revealing cerebellar syndrome]. Rev Neurol (Paris) 2015; 171:674-6. [PMID: 25912281 DOI: 10.1016/j.neurol.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/23/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- E Meriglier
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
| | - O Debouverie
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A Walter-Lepage
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A Brigaud
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - C Beuvon
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - L Luca
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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40
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Zhuang Z, Liu B. The pathogenesis of migrating pseudomeningocele. Br J Neurosurg 2015; 29:445-6. [PMID: 25529968 DOI: 10.3109/02688697.2014.996526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zerui Zhuang
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College , Shantou, Guangdong , P. R. China
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Watchko JF, Painter MJ, Panigrahy A. Are the neuromotor disabilities of bilirubin-induced neurologic dysfunction disorders related to the cerebellum and its connections? Semin Fetal Neonatal Med 2015; 20:47-51. [PMID: 25547431 DOI: 10.1016/j.siny.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Investigators have hypothesized a range of subcortical neuropathology in the genesis of bilirubin-induced neurologic dysfunction (BIND). The current review builds on this speculation with a specific focus on the cerebellum and its connections in the development of the subtle neuromotor disabilities of BIND. The focus on the cerebellum derives from the following observations: (i) the cerebellum is vulnerable to bilirubin-induced injury; perhaps the most vulnerable region within the central nervous system; (ii) infants with cerebellar injury exhibit a neuromotor phenotype similar to BIND; and (iii) the cerebellum has extensive bidirectional circuitry projections to motor and non-motor regions of the brainstem and cerebral cortex that impact a variety of neurobehaviors. Future study using advanced magnetic resonance neuroimaging techniques have the potential to shed new insights into bilirubin's effect on neural network topology via both structural and functional brain connectivity measurements.
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Affiliation(s)
- Jon F Watchko
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Michael J Painter
- Division of Pediatric Neurology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashok Panigrahy
- Department of Pediatric Radiology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
Background:Idiopathic intracranial hypertension (IIH) is a condition that usually affects young, obese women. Management is aimed at controlling symptoms of increased intracranial pressure (ICP) and prevention of visual failure due to papilledema. A common surgical treatment for IIH is the insertion of a lumboperitoneal shunt (LP shunt). Secondary symptomatic tonsillar herniation is an uncommon side effect following lumbar cerebrospinal fluid diversion.Methods:We present two cases of symptomatic secondary tonsillar herniation, one associated with a syrinx, in patients with IIH following valved LP shunting. Treatment options for this side effect may include transplanting the shunt to the ventricular system or decompression of the foramen magnum.Results:In our cases we elected to alter the construct of the LP shunt by inserting a programmable valve which led to clinical and radiological reversal of the tonsillar herniation as well as a dramatic reduction in an associated syrinx.Conclusions:When faced with LP shunt induced symptomatic secondary tonsillar herniation, consideration may be given to altering LP shunt dynamics, prior to inserting a ventricular catheter into normal sized ventricles or decompressing the posterior fossa.
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Affiliation(s)
- Fred C Lam
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
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Rees EM, Farmer R, Cole JH, Haider S, Durr A, Landwehrmeyer B, Scahill RI, Tabrizi SJ, Hobbs NZ. Cerebellar abnormalities in Huntington's disease: a role in motor and psychiatric impairment? Mov Disord 2014; 29:1648-54. [PMID: 25123926 DOI: 10.1002/mds.25984] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/20/2014] [Accepted: 07/13/2014] [Indexed: 03/07/2024] Open
Abstract
The cerebellum has received limited attention in Huntington's disease (HD), despite signs of possible cerebellar dysfunction, including motor incoordination and impaired gait, which are currently attributed to basal ganglia atrophy and disrupted fronto-striatal circuits. This study is the first to investigate a potential contribution of macro- and microstructural cerebellar damage to clinical manifestations of HD. T1- and diffusion-weighted 3T magnetic resonance imaging (MRI) scans were obtained from 12 controls and 22 early-stage HD participants. Manual delineation and voxel-based morphometry were used to assess between-group differences in cerebellar volume, and diffusion metrics were compared between groups within the cerebellar gray and white matter. Associations between these imaging measures and clinical scores were examined within the HD group. Reduced paravermal volume was detected in HD compared with controls using voxel-based morphometry (P < 0.05), but no significant volumetric differences were found using manual delineation. Diffusion abnormalities were detected in both cerebellar gray matter and white matter. Smaller cerebellar volumes, although not significantly reduced, were significantly associated with impaired gait and psychiatric morbidity and of borderline significance with pronate/supinate-hand task performance. Abnormal cerebellar diffusion was associated with increased total motor score, impaired saccade initiation, tandem walking, and timed finger tapping. In conclusion, atrophy of the paravermis, possibly encompassing the cerebellar nuclei, and microstructural abnormalities within the cerebellum may contribute to HD neuropathology. Aberrant cerebellar diffusion and reduced cerebellar volume together associate with impaired motor function and increased psychiatric symptoms in stage I HD, potentially implicating the cerebellum more centrally in HD presentation than previously recognized.
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Affiliation(s)
- Elin M Rees
- University College London, Institute of Neurology, Queen Square, London, UK
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Siddiqi Z, Karoli R, Fatima J, Dey R, Kazmi K. A case of cerebellar dysarthria as the presenting symptom of HIV infection. J Assoc Physicians India 2014; 62:731-733. [PMID: 25856948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 37 year old man presented with progressive dysarthria for 2 weeks. A week later he developed ataxia and bilateral cerebellar signs including intention tremors, dysmetria and dysdiadokokinesia. During evaluation for aetiology of cerebellar dysarthria, MRI brain revealed asymmetric altered signal intensities in bilateral cerebellar hemispheres and right side of pons suggesting demyelinating lesions. ELISA for Human Immune Deficiency virus-1 was positive. We kept a presumptive diagnosis of Progressive Multifocal Leukoencephalopathy (PML) on the basis of clinico-radiological picture. PML is an under investigated and under diagnosed CNS infection seen in HIV patients with advanced disease. We present an unusual case report where isolated cerebellar involvement occurred as the first AIDS defining event in the absence of appreciable immunodeficiency in a patient with previously undiagnosed HIV infection.
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Abstract
BACKGROUND Cerebellar mutism in children occurs after posterior fossa tumor resection and can have lasting effects on cognition, language, and behavior. Cerebellar mutism in acute disseminated encephalomyelitis is rare. PATIENT A 7-year-old boy with a 3-day history of fever, vomiting, and diarrhea presented with altered mental status and expressive aphasia. Magnetic resonance imaging showed new diffusion restriction in the bilateral dentate nuclei and right cerebellum. With treatment, he began to verbalize again but had long-term cognitive and language difficulties. CONCLUSION Acute disseminated encephalomyelitis is commonly a benign process, but its effect on the cerebellum can be long-lasting.
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Affiliation(s)
- Sarah McAndrew
- Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Robert Listernick
- Academic General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nancy Kuntz
- Department of Pediatrics, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
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Castelnovo G, Ratiu D, Taieb G. [Remote cerebellar hemorrhage following spinal surgery]. Rev Neurol (Paris) 2014; 170:467-8. [PMID: 24679483 DOI: 10.1016/j.neurol.2014.01.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/01/2014] [Accepted: 01/04/2014] [Indexed: 11/19/2022]
Affiliation(s)
- G Castelnovo
- Service de neurologie, CHU Caremeau, place du Professeur-Debré, 30029 Nîmes cedex 9, France.
| | - D Ratiu
- Service de neurologie, CHU Caremeau, place du Professeur-Debré, 30029 Nîmes cedex 9, France
| | - G Taieb
- Service de neurologie, CHU Caremeau, place du Professeur-Debré, 30029 Nîmes cedex 9, France
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47
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Africha T, Touati M. Conflit neurovasculaire de l’angle pontocérébelleux. Pan Afr Med J 2014; 18:129. [PMID: 25419267 PMCID: PMC4236767 DOI: 10.11604/pamj.2014.18.129.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/06/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Taoufik Africha
- Service de Radiologie de l'Hôpital Militaire Moulay Ismail Meknès, Maroc
| | - Mohammed Touati
- Service ORL et CCF de l'hôpital militaire Avicenne, Marrakech, Maroc
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48
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Abstract
Subclavian steal syndrome caused by an acute thrombus is very rare. We present a case of cerebellar infarction with proximal subclavian artery thrombosis. A 56-year-old woman was admitted for sudden vertigo. One day prior to admission, she received a shoulder massage comprised of chiropractic manipulation. On examination, her left hand was pale and radial pulses were absent. Blood pressure was weak in the left arm. Downbeat nystagmus and a right falling tendency were observed. Brain MRI showed multiple acute infarctions in the left cerebellum. The findings of Doppler ultrasonography in the left vertebral artery were compatible with a partial subclavian artery steal phenomenon. Digital subtraction angiography demonstrated a large thrombus in the left subclavian artery. After heparin infusion, thrombus size markedly decreased. Cerebellar infarction caused by acute subclavian thrombosis following minor trauma is rare, but the thrombus can be successfully resolved with anticoagulation.
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Affiliation(s)
- Hyeyoung Park
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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49
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Inoue Y, Watanabe M, Ando Y. Brain infarction with a predilection for cerebellum in a patient with double-outlet left ventricle and vascular malformations. J Stroke Cerebrovasc Dis 2013; 23:1232-4. [PMID: 24139408 DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/12/2013] [Accepted: 07/17/2013] [Indexed: 11/18/2022] Open
Abstract
Double-outlet left ventricle (DOLV) is a rare congenital heart disease characterized by the origin of the great arteries arising predominantly or completely from the left ventricle. In this report, we describe a case with brain infarction with a predilection for cerebellum in a patient with DOLV and vascular malformations. The cerebellar predilection of ischemic lesions appeared to have been caused by hemodynamic effects related to the specific anatomy of the brachiocephalic trunk. This is further supported by our observation that the mean flow velocity was significantly higher in the vertebral arteries than in the common carotid arteries.
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Affiliation(s)
- Yasuteru Inoue
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Masaki Watanabe
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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50
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Abstract
Remote cerebellar hemorrhage (RCH) is an unpredictable and rare complication of spinal surgery. We report five cases of RCH following cervical spinal surgery, and summarize another seven similar cases from the literature. Dural opening with cerebrospinal fluid (CSF) hypovolemia seems to be an important factor contributing to RCH following cervical spinal surgery. As other authors have proposed, surgical positioning may be another factor contributing to RCH. RCH is thought to be hemorrhagic venous infarction, resulting from the stretching occlusion of the superior cerebellar vein by the cerebellar sag effect. Either intraoperative CSF loss or a postoperative CSF leak from drainage may cause cerebellar sag, further resulting in RCH. RCH is usually self-limiting, and most patients with RCH have an optimal outcome after conservative treatment. Severe cases that involved surgical intervention because of evidence of brainstem compression or hydrocephalus also had acceptable outcomes, compared to spontaneous CH. It has been suggested that one way to prevent RCH is to avoid extensive perioperative loss of CSF, by paying attention to surgical positioning during spinal surgery. We also underline the importance of early diagnosis and CSF expansion in the early treatment of RCH.
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Affiliation(s)
- Po-Hsien Huang
- Division of Neurosurgery, Department of Surgery, Taoyuan Branch, Taipei Veterans General Hospital, Taoyuan, Taiwan, ROC; National Yang-Miing University School of Medicine, Taipei, Taiwan, ROC
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