Case analysis of crossed cerebellar hemispheric diaschisis in acute stroke patients

S.M. Vinychuk, O.Ye. Fartushna


Background. Stroke is the second-leading global cause of death behind the heart disease, accounting for 11.8 % of total deaths worldwide. The Monakow concept of diaschisis describes neurophysiological changes that occur distant to a focal brain lesion. Diaschisis plays a significant role in the severity of acute neurological deficit and spontaneous stroke recovery. However, currently there are not enough published prospective hospital-based cohort studies that report and analyze clinical characteristics of crossed cerebellar hemispheric diaschisis in acute stroke patients. The purpose of this study is to determine the features of the clinical manifestations of crossed cerebellar hemispheric 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. Materials and methods. We prospectively recruited 124 acute stroke patients, who were admitted to a single department at an academic tertiary care hospital in Kyiv, Ukraine. The primary outcome was the combined incidence of stroke and diaschisis. In the secondary analyses, we evaluated pathophysiological, anatomical, and clinical features specific to crossed cerebellar hemispheric diaschisis in a cohort of acute stroke patients. Results. Among 124 selected acute stroke patients admitted to the department, 42 (33.9 %) persons were diagnosed with different forms of diaschisis. Crossed cerebellar hemispheric diaschisis was diagnosed in 6 patients. We described clinical manifestations and analyzed pathophysiological and clinical features of crossed cerebellar hemispheric diaschisis in acute stroke patients. The main mechanism of crossed cerebellar hemispheric diaschisis is an interruption of efferent impulses at the cerebellar dentate or dentate-thalamo-cortical pathway. Conclusions. Consequently, isolated cerebellar infarctions were manifested not only in ataxic disorders, but also in motor and sensory impairments due to the damage of the frontal-parietal cortex (diaschisis) of the opposite hemisphere of the brain.


crossed cerebellar hemispheric diaschisis; cerebellar stroke; cerebellum; distant diaschisis; forms of diaschisis; clinical manifestations; diagnosis; case report

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Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics¾2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67-e492. doi:

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:

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

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.

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

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

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. 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)

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).

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:

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

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. 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:

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

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

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

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

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)

Vinychuk SM, Fartushna OYe. Cerebrospinal and commissural diaschisis in acute stroke patients: case analysis. International Neurological Journal. 2018;5(99):28-33 doi:

Vinychuk SM, Fartushna OYe. Cross-cerebellar diaschisis in acute stroke patients: case analysis and report. International Neurological Journal. 2018;6(100): 15- 20 doi:

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:

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

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:

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

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.

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

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).

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).

Pereverzev I. Brain metabolic disturbances in patients with prior cerebellar stroke / I. Pereverzev // Doctor: Monthly scientific practical journalistic journal. 2010;5:77-79. (in Russian)

Crisomoto RA. Corcia MM, Tong DC. Detection of diffusion – weighted attack and minor stroke patients using acute magnetic resonanse imaging. Ann. Neurol. 2003;57(6):848-859. doi:

Grips E. Sedlaczek O, Bäzner H, et al. Supratentorial age-related white matter changes predict outcome in cerebellar stroke. J.Cereb. Blood Flow Metab. 2005;36(9):1988-1998. doi:

Holmes G. The cerebellum of man. Brain. 1930;62:1-30.


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