Cerebrospinal and commissural diaschisis in acute stroke patients: case study

S.M. Vinychuk, O.Ye. Fartushna


Background. Stroke remains the second leading cause of disability and death with the highest reported age­standardized death rates in Eastern Europe compared to Western Europe and the US. Recovery from stroke has been shown to involve reorganization in motor and premotor cortical areas. The resolution of diaschisis has been suggested as a mechanism of early spontaneous recovery. However, there are not enough published prospective studies on the clinical analysis and comparison of different types of cerebral diaschisis, especially in acute stroke patients. We aimed to carry out follow­up analysis of clinical characteristics of cerebrospinal and commissural cerebral diaschisis in acute ischemic stroke patients, to present clinical cases. Materials and methods. We have conducted a prospective, hospital­based, cohort study of acute stroke patients (n = 124) who were admitted to the department of cerebrovascular diseases of the University Hospital (Oleksandrivska Clinical Hospital, Kyiv, Ukraine) within the first 24 hours after the stroke. All cases were reviewed by at least two board­certified neurologists trained in cerebrovascular diseases. All participants underwent comprehensive clinical, neurological, laboratory, ultrasound, and neuroimaging examination. Results. Among 124 patients, 26 were diagnosed with cerebral diaschisis (cerebrospinal (n = 22) and commissural (n = 4)). We have provided detailed clinical analysis of cerebral diaschisis in acute stroke patients. We have described specific neurological changes in variants of territorial cerebral infarctions and mirror brain infarctions caused by diaschisis. Conclusions. Semiotics of acute cerebral stroke is determined, not only by the primary brain infarction, but also by the diaschisis that causes more severe neurological deficit. Cerebral diaschisis is associated with the mirror brain infarction development, depression of tendon and periosteal reflexes, limb muscle atony. During therapy, a sluggish stage of hemiplegia in most cases was followed by the spastic hemiplegia within 9 to 14 days after stroke development.


diaschisis; cerebral diaschisis; cerebrospinal diaschisis; commissural diaschisis; clinical features; stroke; acute ischemic stroke; case; case report

Full Text:



Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67-e492. doi: 10.1161/CIR.0000000000000558

Thrift AG, Thayabaranathan T, Howard G, et al. Global stroke statistics. International Journal of Stroke. 2017;12(1):13-32. doi: 10.1177/1747493016676285

Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. The Lancet. 2014;383(9913):245-54. PMID: 24449944

Mackay J, Mensah GA. The atlas of heart disease and stroke. World health organization and Center for disease control and prevention. 1st ed. Geneva: World Health Organization; 2004. 112 p. ISBN: 9241562765

Vinychuk SM, Prokopiv MM. Gostryj ishemichnyj insul't [Acute ischemic stroke]. Kyiv: Naukova dumka; 2006. 286 p. (in Ukrainian) ISBN: 966-00-0615-2

Evtushenko SK, Filimonov DA, Yevtushenko IS. New risk factors of stroke in young adults S.K. Yevtushenko. Zhurnal Nevrologii i Psikhiatrii imeni SS Korsakova. 2015;115(12):3-12. doi: 10.17116/jnevro20151151223-12

Fartushna OYe, Vinychuk SM. Detection and removal of vascular risk factors as important area of primary prevention of transient ischemic attack. Ukrainian Medical Journal. 2015;1(105):23-27. (in Ukrainian)

World Stroke Organization. Facts and Figures about Stroke. Available from:

Snow S. J. Stroke and t-PA—Triggering New Paradigms of Care. The New England journal of medicine. 2016;374(9):809. doi: 10.1056/NEJMp1514696

Mishchenko TS. Epidemiology of cerebrovascular diseases and organization of medical care for patients with stroke in Ukraine. Ukrains'kyi Visnyk Psykhonevrolohii. 2017;1(90):22-24. (in Russian)

Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circulation research. 2017;120(3):439-448. doi: 10.1161/CIRCRESAHA.116.308413.

Lees R, McGrane F, Fartushna O, et al. The pattern of cognitive impairment in stroke survivors with carotid stenosis. International Journal of Stroke. 2014;9(3):323-324.

Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135(10):229-445. doi: 10.1161/CIR.0000000000000485.

Wilkins E, Wilson LK, Wickramasinghe et al. European cardiovascular disease statistics 2017. Brussels: European Heart Network; 2017. 188 p.

Vinychuk SM, Fartushna OYe. Early rehabilitation after acute ischemic cerebrovascular events. International Neurological Journal. 2016;8(86):34-39. (in Ukrainian) doi:

Fartushna OYe, Vinychuk SM. Tranzytorni ishemichni ataky [Transient Ischemic Attacks]. Kyiv: PH «Avitsena»; 2014. 216 p. (in Ukrainian). ISBN 978-966-2144-70-3

Fartushna OYe, Vinychuk SM. Behavioral risk factors modification as a component of primary prevention of transient ischemic attack and/or stroke. Ukrainian Medical Journal. 2014;6(104):42-44. (in Ukrainian).

GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151-1210. doi:

Wang H, Naghavi M, Allen C et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The lancet. 2016;388(10053):1459-1544. doi:

Finegold JA, Asaria P, Francis DP, Finegold JA. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. International journal of cardiology. 2013;168(2):934-945. doi: 10.1016/j.ijcard.2012.10.046

Fartushna OYe, Vinychuk SM. Epidemiology of transient ischemic attacks in the structure of acute cerebrovascular disorders in Ukraine and in other countries. International Neurological Journal. 2017;5 (91):105-111. (in Ukrainian). doi: 10.22141/2224-0713.5.91.2017.110863

Fartushna OYe, Prokopiv MM. Actuality of the problem of cerebrovascular diseases, transient ischemic attacks, and improvement of their diagnostics in the health care system in Ukraine. Problems in military health care. 2007;19:335-342. (in Ukrainian).

Ovbiagele B, Nguyen-Huynh MN. Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy. Neurotherapeutics.2011;8(3):319–329. doi: 10.1007/s13311-011-0053-1

Feigin, VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurology. 2016;15(9):913-924. doi: 10.1016/S1474-4422(16)30073-4

Fartushna OY. Emergency therapeutic approach as a secondary prevention of an acute ischemic stroke in patients with TIA. In XX-th World Neurological Congress (WNC). 2011 Nov 12–17, Marrakesh, Morocco.

Seitz R.J, Azari NP, Knorr U, et al The role of diaschisis in stroke recovery. Stroke. 1999;30(9):1844-50. PMID: 10471434

Vinychuk SM. Dyashyz pry mozgovom ynsul'te [Diaschisis in patients with cerebral stroke]. Kyiv: PH «OZhYVA»; 2017. 64 p. (in Russian).

Die Lokalisation im Grosshirn und der Abbau der Funktion durch Kortikale Herde. Journal of the American Medical Association. 1914;LXIII(9):797. (in German) doi: 10.1001/jama.1914.02570090083033.

Vinychuk SM, Fartushna OYe. Diaschisis: brief historical review. International Neurological Journal. 2018;4(98):6-10 doi:

Vinychuk SM, Fartushna OYe. Istorija Kyi'vs'koi' nevrologichnoi' shkoly [The history of Kyiv neurological school]. Kyiv: Edvans-Print; 2015. 55 p. (in Ukrainian). ISBN 978-617-7335-02-2

Carrera E, Tononi G. Diaschisis: past, present, future. Brain. 1911;137(9):2408-2422.

Engelhardt E, Gomes MM. Shock, diaschisis and von Monakow. Arq Neuropsiquiatr. 2013;71:487-489. doi: 10.1590/0004-282X20130067

Finger S, Koehler PJ, Jagella C. The von Monakow concept of diaschisis: origins and perspectives. Archiv Neurologie. 2004;61:283—288. doi: 10.1001/archneur.61.2.283

Jagella C, Isler H, Hess K. 100 Jahre Neurologie an der Universität Zürich 1894 bis 1994 - Constantin von Monakow (1853 bis 1930). Schweiz Arch Neurol Psychiatr. 1994;145 (suppl. 1):1–61. (in German).

Monakow CV. Über den gegenwärtigen Stand der Frage nach der Lokalisation im Grosshirn. Ergebnisse der Physiologie. 1904;3(2):100–22. doi: 10.1007/bf02320980

Andrews RJ. Transhemispheric diaschisis. A review and comment. Stroke. 1991;22(7):943–9. doi: 10.1161/01.str.22.7.943.

Fartushna OYe. Patogenetychni pidtypy tranzytornyh ishemichnyh atak: osoblyvosti nevrologichnoi' kliniky, gemodynamiky ta likuvannja [Pathogenetic subtypes of transient ischemic attacks: features of neurological clinic, hemodynamics, and treatment]. Kyiv. Bogomolets National Medical University; 2012. 217 p. (in Ukrainian).

Cherenko TM, Fartushna OY. Features of cerebral hemodynamics in patients with different pathogenetic subtypes of transient ischemic attacks. Military medicine of Ukraine. 2011;11(1):75-82. (in Ukrainian)

Cherenko TM, Fartushna OY, Atamanenko OA, et al. Clinical and hemodynamic features in patients with different pathogenic subtypes of transient ischemic attacks. Ukrainian medical Journal. 2011;3(83):95-100. (in Ukrainian)

Koehler PJ, Jagella C. Constantin von Monakow (1853–1930). Journal of Neurology. 2002;249(1):115–6. doi: 10.1007/pl00007841

Vynychuk SM. Diaschisis and its role in the development of reflex-motor disturbances in cerebral stroke. Ukrainian Medical Journal. 2013;2(94):143-7. (in Russian)

Kernan WN, Ovbiagele B, Black HR, et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160— 2236. doi: 10.1161/STR.0000000000000024.

Aho K, Harmsen P, Hatano S, et al. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ. 1980;58:113-130. PMID: 6966542

Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41. PMID: 7678184

Gooley TA. Leisenring W, Crowley J, et al. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Statistics in Medicine. 1999;18(6):695-706. PMID: 10204198

Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37(2):577-617. doi: 10.1161/01.STR.0000199147.30016.74

Ringleb P,. Schellinger PD, Hacke W, et al. European Stroke Organisation 2008 guidelines for managing acute cerebral infarction or transient ischemic attack. Part 1. Der Nervenarzt. 2008;79(8):936-957. (in German). doi: 10.1007/s00115-008-2531-1

Vinychuk SM, Fartushna ОYe. Atorvastatin and its role in the prevention and treatment of ischemic cerebrovascular events. Medychna hazeta Zdorov'ya Ukrayiny. 2015;9(358):3. (in Ukrainian).

Fartushna OY, Vinychuk SM. An important direction of reducing the risk of recurrent transient ischemic attacks and / or stroke is applying of optimal dose of Тorvakard. Family Medicine. 2015; 3(59):223-227. (in Ukrainian).

Vinychuk SM, Fartushna ОY. Differential treatment of transient ischemic attack is effective way to prevent recurrent acute cerebral events. International Neurological Journal. 2014;6(68):87-92. (in Ukrainian).

Vinychuk SM, Fartushna ОE. Educational programs of transient ischemic attacks/stroke prevention. Ukrainian Medical Journal. 2014;5(103):49-51. (in Ukrainian).

Fartushnaya EE, Vinychuk SM. Reducing the risk of recurrent ischemic stroke, after transient ischaemic attack along with neuroprotektiv and antiagregant therapy. In XIV International Congress of Rehabilitation Medicine and immunorehabilitation. 2009 Oct 16-21; Tel-Aviv, Israel.

Vinychuk SM, Fartushna ОYe. Early rehabilitation after acute ischemic cerebrovascular events. International Neurological Journal. 2016;8(86):34-39. (in Ukrainian). doi: 10.22141/2224-0713.8.86.2016.90909

Fartushna OYe, Vinychuk SM. Brain injury in patients with acute TIA: clinical features in different TIA subtypes. International Neurological Journal. 2017;3(89):13-18. doi:

Fartushna OE. TIA with new ischemic lesions: clinical features and stroke risk for patients with different TIA pathological subtypes. In 15-th Congress of the European Federation of Neurological Societies (EFNS). 2011 Sep 10-13; Budapest, Hungary.

Fartushna O, Dani K, Lees RA, McGrane F, Vusirikala A, Broomfield NM, Dawson J. White matter hyper-intensities on brain MRI are common in patients with carotid stenosis. International Journal оf Stroke. 2014;9(3):129.

Fazekas F, Payer F, Valetitsch H. Brain stem infarction and diaschisis. A SPECT cerebral perfusion study. Stroke. 1993;24 (8):1162-1166.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2018


   Seo анализ сайта