Phenomenon of Diaschisis after Acute Cerebral Stroke: Clinical Manifestations and Diagnosis

S.M. Vinichuk, A.S. Trepet

Abstract


The objective of our study — to determine the peculiarities of clinical manifestations of the main forms of diaschisis on different levels of the central nervous system after acute cerebral stroke and to increase the efficiency of its diagnosis by comparing obtained data with MRI findings. We have examined 52 patients with acute cerebral infarctions and described clinical manifestations of various forms of diaschisis: cerebrospinal, commissural, crossed cerebellar-hemispheric, crossed cerebellar and crossed pontine-cerebellar. From the standpoint of K. Monakov theory of diaschisis, we gave a scientific explanation of the pathophysiology of areflexia, atony on the side of hemiplegia after hemispheric stroke with a lesion of the pyramidal system and the analysis of the mechanisms of «mirror» infarction in commissural and distant forms o diaschisis. For the first time in domestic literature, there were describes the clinical manifestations of distant forms of cerebral diaschisis. Neurological disorders of crossed cerebellar hemispheric diaschisis at unilateral cerebellar infarction were studied in depth, it is shown that it often formed in the contralateral cortex of the frontal and fronto-parietal lobes of the brain, and in 87.5 % of cases was accompanied by structural changes according to MRI data. Results of the study showed that cerebellar infarction was associated with not only typical symptoms of cerebellar lesion, but also with paresis, disturbance of sensitivity and higher brain functions. Further study of the issues addressed in this article will help to improve the diagnosis and management of patients with acute hemispheric and cerebellar stroke.


Keywords


cerebral stroke; forms of diaschisis; clinical manifestations; diagnosis

References


Виничук С.М. Диашиз и его роль в развитии рефлекторно-двигательных расстройств при мозговом инсульте // Укр. медичний часопис. — 2013. — № 2. — С. 143-147.

Von Monakow C. Neuegesichtspubcte in der frage nach der lokalisation im grosshirm. — Wiesbaden: J.F.Bergman, 1911. — 20 s.

Von Monakow C. Die Lokalisation im Grosshirm und der Ablau der Function dürch korticale Herde. — Wiesbaden: J.F. Bergmann, 1914. — 1033 s.

Heiss W.D., Pawlik G., Wagner R. et al. Functional hypometabolism of noninfarcted brain regions in ischemic stroke // J. Cereb. Blood. Flow Metab. — 1983. — Vol. 3 (suppl. 1). — P. 582-583.

Kushner M., Alavi A., Reivich M. et al. Contrаlateral cerebellar hypometabolism following cerebral insult: a positron emission tomographic study // Ann. Neurol. — 1984. — Vol. 15. — P. 425-427.

Feeney D.M., Baron J.C. Diaschisis // Stroke. — 1986. — Vol. 17. — P. 817-830.

Yamauchi H., Fukuyama H., Kimura J. Hemodynamic and metabolic changes in crossed cerebellar hypoperfusion. — 1992. — Vol. 23. — P. 855-860.

Baron J.C., Bousser M.G., Comar D. et al. Crossed cerebellar diaschisis in human supratentorial brain infarction // Trans. Am. Neurol. Assoc. — 1981. — Vol. 105. — P. 459-461.

Perani D., Gerundini P., Lenz G.L. Cerebral hemispheric and contralateral cerebellar hypoperfusion during a transient ische-mic attack // J. Cereb. Blood. Flow Metab. — 1987. — Vol. 7. — P. 817-830.

Infeld B., Davis S.M., Lichtenstein M. et al. Crossed cerebellar diaschisis and brain recovery after stroke // Stroke. — 1985. — Vol. 26. — P. 90-95.

Small S.I., Hlustic P., Noll D.C. et al. Cerebellar hemispheric activation ipsilateral to the paretic hand correlateral with functional recovery after stroke // Stroke. — 2002. — Vol. 125. — P. 1544-1557.

Pantano P., Baron J.C., Samson J. et al. Crossed cerebellar diaschisis: further studies // Brain. — 1986. — Vol. 109. — P. 677-694.

Brodal P., Bjaallie J.G. Salient anatomic features of the cortico-ponto-cerebellar pathway // Brog. Brain Res. — 1997. — Vol. 114. — P. 227-249.

Bowler J.U., Wade J.P.H. Ipsilateral cerebellar diaschisis following pontine infarction // Cerebrovasc. Dis. — 1991. — Vol. 1. — P. 58-60.

Schmahmann J.D., Caplan D. Cognition, emotion and

cerebellum // Brain. — 2006. — Vol. 129. — P. 288-292.

Reinhard M., Waldkircher Z., Timmer J. et al. Cerebellar autoregulation dynamics in humans // J. of Cerebral Blood Flow Metab. — 2008. — Vol. 28. — P. 1605-1612.

Broich K., Hartmann A., Biersack H.J., Horn R. Crossed cerebello-cerebral diaschisis in a patient with cerebellar infarction // Neurosci. Lett. — 1987. — Vol. 83(1–2). — P. 7-12.

Kimura S., Nakamura H, Matsumura K. et al. Crossed «cerebral» diaschisis? Seven cases with unilateral cerebellar vascular lesion which showed decreased perfusion in the contralateral cortex // Kaku-Igaku. — 1989. — Vol. 26. — P. 1259-1266.

Rousseaux M., Steinling M. et al. Crossed hemispheric diaschisis in unilateral cerebellar lesions // Stroke. — 1992. — Vol. 23. — P. 511-514.

Переверзев И.В. Особенности метаболизма головного мозга при инсульте мозжечка: Дисс… канд. мед. наук. — М., 2011. — 116 с.

Botez M.I., Leveilee J., Lambert R. et al. Single photon emission computed tomography (STECT) in cerebellar disease: cerebello-cerebral diaschisis // Eur. Neurol. — 1991. — Vol. 31. — P. 405-412.

Fazekas F., Payer F., Valetitsch H. et al. Brain stem infarction and diaschisis: a SPECT cerebral perfusion study // Stroke. — 1993. — Vol. 24. — P. 1162-1166.

Fulham M.J., Brooks R.A., Hallet M. et al. Cerebellar diaschisis revisited: pontine-hypometabolism and dentate sparing // Neurology. — 1992. — Vol. 42. — P. 2267-2273.

Trouillas P., Takayanagi T., Hallet M et al. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. The Ataxia Neuropharmacology Committee of the World Federation of Neurology // J. Neurol. Science. — 1997. — Vol. 145. — P. 205-211.

Виленский Б.С. Инсульт. — СПб.: Мед. информ. агентство, 1995. — 287 с.

Віничук С.М. Судинні захворювання нервової системи. — К.: Наук. думка, 1999. — 250 с.

Baron J.C. Pathophysiology of acute cerebral ischemia: PET studies in humans // Cerebrovasc. Dis. — 1991. — Vol. 1 (Suppl. 1). — P. 22-31.

Schmahmann J.D. The role of the cerebellum in affect and psychosis // J. Neuroling. — 2000. — Vol. 13. — P. 189-214.

Schoch B., Dimitrova A., Gizewski E.R. et al. Functional localization in the human cerebellum based on study of 90 patients // Neuroimage. — 2006. — Vol. 30. — P. 36-51.

Tavano A., Grasso R., Gagliandi C. et al. Disorders of cognitive and affective development in cerebellar malformations // Brain. — 2007. — Vol. 130. — P. 2646-2660.

Habas C., Kamdar N., Nguyen D. et al. Distinct cerebellar contributions to intrinsic connectivity networks // J. Neurosci. — 2009. — Vol. 29. — P. 8586-8594.

Strick P.L., Dum R.P., Fiez J.A. Cerebellum and nonmotor function // Ann. Rev. Neurosci. — 2009. — Vol. 32. — P. 413-434.

O¢Reilly J.X., Beckmann C.F., Tomassini V. et al. Distinct and overlapping functional zones in the cerebellum defined by resting state function connectivity // Cereb. Cortex. — 2010. — Vol. 20. — P. 953-965.

Stoodley C.J., Schmahmann J.D. Evidence for topographic organization in the cerebellum of motor control versus cognitive and affective processing // Cortex. — 2010. — Vol. 46. — P. 831-844.

Krienen F.M., Buckner R.L. Segregated fronto-cerebellar circuits revealed by intrinsic functional connectivity // Cereb. Cortex. — 2009. — Vol. 19. — P. 2485-2497.

Holmes G. The cerebellum of the man // Brain. — 1930. — Vol. 62. — P. 1-30.




DOI: https://doi.org/10.22141/2224-0713.6.68.2014.80749

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