Crossed cerebellar diaschisis in acute stroke patients: case analysis and report
Background. Stroke represents a highrisk condition for longterm disability and death. The role of diaschisis in the severity of acute neurological deficit and spontaneous stroke recovery is significant. However, currently there are not enough published prospective, hospitalbased, cohort studies that report and analyze clinical characteristics of crossed cerebellar diaschisis in acute stroke patients. Moreover, modern stroke treatment may change clinical representation of diaschisis. The purpose of this study is to determine the features of the clinical manifestations of crossed cerebellar diaschisis after acute cerebral stroke and to improve the efficiency of its diagnosis by comparing the obtained data with the results of the magnetic resonance imaging findings. Materials and methods. We prospectively recruited 124 acute stroke patients, who were admitted to a single department of the academic tertiary care hospital in Kyiv, Ukraine. The primary outcome was the combined incidence of stroke and diaschisis. In the secondary analyses, we studied pathophysiological, anatomical, and clinical features specific to crossed cerebellar diaschisis in a cohort of acute stroke patients with diaschisis. Results. Among 124 selected acute stroke patients admitted to the department, 42 (33.9 %) persons were diagnosed with different forms of diaschisis: cerebrospinal (n = 22), commissural (n = 4), crossed cerebellar (n = 5), crossed cerebellarhemispheric (n = 6), crossed and pontocerebellar diaschisis (n = 5). We have conducted a detailed pathophysiological and clinical analysis of crossed cerebellar diaschisis in acute ischemic stroke patients, described clinical manifestations of crossed cerebellar diaschisis. Utilizing the von Monakow theory of diaschisis, we found a scientific explanation for the pathophysiology of clinical manifestations of that remote form of diaschisis. Conclusions. results of this study showed that cerebellar infarction is associated not only with typical symptoms of cerebellar lesion, but also with paresis, disturbances of sensitivity, and higher mental functions. Further study of the issues addressed in this article will help to improve the diagnosis and management of patients with acute cerebellar stroke.
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