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NEURORADIOLOGY HEAD AND NECK IMAGING Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 2  |  Page : 203-204
Crossed cerebellar atrophy after supratentorial hemispheric atrophy


Govt. Medical College and Rajindra Hospital, Patiala, India

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Keywords: Cerebellar atrophy, Diaschisis

How to cite this article:
Mathur M. Crossed cerebellar atrophy after supratentorial hemispheric atrophy. Indian J Radiol Imaging 2002;12:203-4

How to cite this URL:
Mathur M. Crossed cerebellar atrophy after supratentorial hemispheric atrophy. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Nov 18];12:203-4. Available from: http://www.ijri.org/text.asp?2002/12/2/203/28444
A thirty year old woman presented with history of weakness of left half of body for last 10 years. Power was grade two to three in the left upper and lower limbs. She had developed severe cerebellar signs on the left side for last 3-4 years. A non contrast CT scan was performed which revealed a large porencephalic cyst in the right cerebral hemisphere and severe left cerebellar atrophy. There was severe volume loss in the left cerebellar hemisphere with prominent folia. The fourth ventricle and the left pericerebellar cisterns were dilated. The cause of porencephalic cyst was not known. The patient did not have any prior CT. The patient was diagnosed as having left cerebellar hemisphere atrophy following contralateral cerebral atrophy.


   Discussion Top


In 1980, Baron et al used the term crossed cerebellar diaschisis to define a condition in which a reduction in blood flow and oxygen utilisation occurs in the cerebellar hemisphere contralateral to a supratentorial infarct [1] Since then this condition has been observed in patients with supratentorial tumors, arteriovenous malformations and haemorrhage [5]. Interruption of cerebropontine-cerebellar pathway which is predominantly excitatory is thought to be the mechanism of this remote transneuronal metabolic depression [4]. This phenomenon has been identified on positron emission tomographic (PET) scans in which cerebellar hypometabolism is ascribed to functional disconnection of the cerebellar hemisphere from the contralateral cerebral cortex [2],[5] or thalamus [3].

Diaschisis may be classified according to the connecting fibres involved. When the connecting fibres are intra hemispheric, the phenomenon of ipsilateral thalamic or subcortical-cortical diaschisis may be seen; when they are interhemispheric, there is transcallosal diaschisis and if they are cerebellar, the diaschisis is of the contralateral cerebellum or crossed cerebellar diaschisis [7].

Crossed cerebellar diaschisis may evolve into crossed cerebellar atrophy or it may resolve with time [6]. The mechanisms by which cerebellar metabolism returns to normal are unknown. The corticopontine-cerebellar fibres are predominantly excitatory and most of them originate from frontal and parietal cortices. The origin of these fibres from frontal and parietal cortices is suggested by the fact that prevalence of crossed cerebellar atrophy is highest in patients with infarction in the territory of deep middle cerebral artery. The injury to the cerebral hemisphere has to be considerably large to produce contralateral cerebellar atrophy [4].

Furthermore cerebellar hypometabolism in early sub acute stage in patients with supratentorial infarct indicates a worse clinical outcome [8].

MR remains the ideal modality for the diagnosis of posterior fossa lesions but CT especially coronal images can identify this entity equally well. Although  Wallerian degeneration More Details following neuronal death is a well established fact, the concept of transsynaptic neuronal degeneration remains a physiological and radiological curiosity.

 
   References Top

1.Baron JC, Bousser MG, Comar D, Castaigne P. "Crossed Cerebellar diaschisis" in human supratentorial infarction (abstract). Ann Neurol 1980;128:8  Back to cited text no. 1    
2.Martin WRW, Raichle ME. Cerebellar blood flow and metabolism in cerebral hemispheric infarction. Ann Neurol 1983;14:168-176.  Back to cited text no. 2    
3.Chung HD. Retrograde Crossed Cerebellar Atropy. Brain 1985;108:881-895.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Freeney DM, Baron VC. Diaschisis. Stroke 1986;17:817-830.  Back to cited text no. 4    
5.Tien RD, Ashdown BC. Crossed Cerebellar diaschisis and crossed cerebellar atrophy: Correlation of MR findings, clinical symptoms and supratentorial diseases in 26 patients. AJR 1992;158:1155-1159.  Back to cited text no. 5  [PUBMED]  
6.Gupta N, Jankharia B, Choksi V, Dhamankar S. Crossed Cerebellar Atrophy after Supratentorial Hemispheric Atrophy: CT findings. AJR 1994;163:750.  Back to cited text no. 6    
7.Gonazalez AE, Marti FJ, Marte VJL. The phenomenon of diaschisis in cerebral vascular disease. Rev Neurol 2000 May 16-31;30 (10): 941-5.  Back to cited text no. 7    
8.Takasawa M, Watanabe M, Yamanoto S. et al . Prognostic value of subacute crossed cerebellar diaschisis: single photon emission CT study in patients with middle cereberal artery territory infarct. AJNR 2002; Feb; 23 (2): 189-93.  Back to cited text no. 8    

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Correspondence Address:
M Mathur
2014, Lal Bagh Street, Patiala-147001
India
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Source of Support: None, Conflict of Interest: None


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