Cerebellar Motor Syndrome in Acute Isolated Infarctions of the Cerebellum: Clinical Manifestations, Diagnosis and Treatment

S.M. Vinychuk, O.A. Myalovytska, G.S. Trepet, L.M. Trepet

Abstract


Objective of our study was to increase the efficiency of diagnostic of the severity of the cerebellar motor syndrome in patients with acute isolated cerebellar infarction using International Cooperative Ataxia Rating Scale (ICARS) and to determine peculiarities of recovering of motor functions on the basis of complex treatment. We included 20 patients with benign cerebellar infarctions. Outcome analysis showed that clinical manifestations and severity of cerebellar motor deficit after cerebellar infarction depended on the localization of involved anatomic structures and arterial areas of vascularization. Volume of motor deficit by ICARS in patients with infarction in the area of superior cerebellar artery (33.80 ± 3.16) and inferior posterior cerebellar artery (73.80 ± 3.97) corresponded moderate ataxia; infarctions in the area of vascularization in inferior anterior cerebellar artery manifested with mild ataxic deficit (18.00 ± 3.41). Combined therapy with the use of traditional methods and drugs with protective and neurometabolic action — Ceraxon (citicoline) and Actovegin — significantly increased the efficiency of recovery of motor function during the first 2 weeks after the onset of a heart attack. Such ataxia syndrome manifestations, as dizziness, dysarthria, and unsteadiness when walking, were particularly resistant to treatment.

Keywords


cerebellum; isolated infarction; cerebellar motor syndrome; diagnosis; ataxia scale; treatment

References


Кроль М.Б., Федорова Е.А. Основные невропатологические синдромы. — М.: Медицина, 1966. — 511 с.

Винницький О.Р. Аналітична невропатологія. — К.: Здоров’я, 1972. — 236 с.

Bastian A.J. Cerebellar limb ataxia: Abnormal control of self-generated and external forces // An. N. J. Acad. Sci. — 2002. — Vol. 978. — P. 16-27.

Konczak J., Pierscianec D., Hirsiger S. et al. Recovery of upper limb function after cerebellar stroke // Stroke. — 2010. — Vol. 41. — P. 2191-2200.

Ганонг В.Ф. Фізіологія людини: підручник. — Львів: БаК, 2002. — 784 с.

Babinski J. Asynergie et inertie cérébelleuse. // Rev. Neurol. — 1906. — Vol. 14. — P. 685-686.

Sander T., Sprenger A., Neumann G. et al. Vengence deficits in patients with cerebellar lesions // Brain. — 2009. — Vol. 132. — P. 103-115.

Babinski J., Tournay A. Symptomes des maladies du cervelet // Rev. Neurol. — 1913. — Vol. 18. — P. 306-322.

Holmes G. The symptoms of acute cerebellar injuries due to gunshot injuries // Brain. — 1917. — Vol. 40. — P. 463-535.

Karaci R., Ozturk S., Ozbakir S. et al. Evaluation of language functions in acute cerebellar vascular diseases // J. Stroke Cerebrovasс. Dis. — 2008. — Vol. 17. — P. 251-256.

Kark R.A.P., Budelli M.M.R., Wachsner R. Double-blind, triple-crossover trial of low doses of oral physostigmine in inherited ataxias // Neurology. — 1981. — Vol. 31. — P. 288-292.

Волосовець А.О. Нейрогенна ротоглоткова дисфагія в гострий період мозкового інсульту: механізми виникнення, методи діагностики та ведення хворих: Дис... канд. мед. наук. — Київ, 2011. — 169 с.

Kwon M., Lee J.H., Kim J.S. Disphagia in unilateral medullary infarction: lateral us medial lesions // Neurology. — 2005. — Vol. 65. — P. 714-718.

Schmahmann J.D., MacMore J. Jange M. Cerebellar stroke without motor deficit: Clinical evidence for motor and non-motor domains within the human cerebellum // Neuroscience. — 2009a. — Vol. 162, № 3. — P. 852-861.

Sobué T., Takayamagi T., Nakanishi T. et al. Controlled trial of thyrotropin releasing hormone tartrate in ataxia of spinocerebellar degenerations // J. Neurol. Sci. — 1983. — Vol. 61. — P. 235-248.

Filla A.G., De Michele A., Mengano L. et al. Chronic administration of TRH-Tartrate in inherited ataxias: double blind cross-over trial in 30 patients. In New Prospects in Clinical Neuropharmacology. John Libbey. — 1988. — P. 189-209.

Trouillas P., Brudon F., Adeleine P. Improvement of cerebellar ataxia with levorotary form of 5-hydroxytryptophan. A double-blind study with quantified data processing // Arch. of Neurol. — 1988. — Vol. 45. — P. 1217-1222.

Chamberlain S.N., Robinson J., Walker C. et al. Effect of lecithin on disability and plasma free choline levels in Friedreih’s ataxia // J. Neurol. Neurosurg Psychiatry. — 1980. — Vol. 43. — P. 843-845.

Stolze H., Klebe S., Pefersen G. et al. Typical features of cerebellar ataxic gait // J. Neurol. Neurosurg. Psychiatry. — 2002. — Vol. 73. — P. 310-312.

Berg K.O., Wood-Dauphine S.L., Williams J.I. The balance scale: reliability assessment with elderly residents and patients with an acute stroke. // Scand. J. Rehabil. — 1995. — Vol. 27. — P. 27-36.

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.

Schmahmann J.D., Gardner R., MacMore J. et al. Deve-lopment and evalution of a brief ataxia rating scale (BARS) from a modified form of the ICARS // Movement Disorders. — 2009б. — Vol. 24, № 12. — P. 1820-1828.

Storey E., Tuck K., Hester R., Churchyard A. Inter-rater realibility of the International Cooperative Ataxia Rating Scale (ICARS) // Mov Disord. — 2004. — Vol. 19. — P. 190-192.

Lyden P., Trott T., Tilley B. et al. Improved reability of the NIN Stroke Scale using video training. NINDS tPA Stroke Study Group // Stroke. — 1994. — Vol. 25. — P. 2220-2226.

Rankin J. Cerebral Vascular accidents in patients over the age of 60: prognosis // Scott. Med. J. — 1997. — Vol. 2. — P. 200-215.

Schmahmann J.D., Doyon J., Toga A. et al. MRI Atlas of the human cerebellum San Diego, GA: Academic Press, 2000. — 167 p.

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

Ye B.S., Kim J.D., Nam H.S. et al. Clinical manifestations of cerebellar infarcts according to specific lobular involvement // Cerebellum. — 2010. — Vol. 9. — P. 571-579.

Tatu L., Maulin T., Bogousslavsky J. et al. Arterial territories of human brain: brainstem and cerebellum // Neurology. — 1996. — Vol. 47, № 5. — P. 1125-1135.

Amarenco P., Cuse C.S., Rosengart A. et al. Very small (border zone) cerebellar infarcts: distribution, mechanisms causes and clinical features. // Brain. — 1993. — Vol. 116. — P. 161-186.

Caplan L.R. Handbook of clinical neurology // Ataxia Disorders. — 2012. — Vol. 103. — 3rd series.

Kumral E., Kisabay A., Atac C. et al. Spectrum of the posterior inferior cerebellar artery territory infarcts. Clinical-diffusion — Weighted imaging correlates // Cerebrovas. Dis. — 2005. — Vol. 20. — P. 370-380.

Lee H., Yi H.A., Cho Y.W. et al. Modulus infarction mimicking acute peripheral vestibulopathy // Neurology. — 2003. — Vol. 60. — P. 1700-1702.

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

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

Botez M.I., Léveilé J., Lambert R et al. Single photon emission computed tomography (SPEKT) in cerebellar disease: cerebello-cerebral diaschisis // Eur. Neurol. — 1991. — Vol. 31, № 6. — P. 405-412.

Klein J. Membrane breakdown in acute and chronic neurodegeneration: focus on choline-containing phospholipids // J. Neurol. Transm. — 2000. — Vol. 107. — P. 1027-1063.

Farooqui A.A., Ong W.J., Horrocks L.A. Bicemical aspects of neurodegeneration in human brain: involvement of neural membrane phospholipids and phospholipades A2 // Neurochem. Rem. — 2004. — Vol. 13. — P. 1961-1977.

Donnan G.A., Baron J., Davis S. et al. The ischemic penumbra: overviev, definition and criteria / Donnan G., Baron J., Davis S. et al. The ischemic penumbra: pathophysiology, imayung and therapy. — New York: Informa Healthcare, 2007. — P. 7-20.

Kohrman M., Sauer R., Hagen B. et al. MRI Mismatch-Based intravenous thrombolysis for isolated cerebellar infarction // Stroke. — 2009. — Vol. 40. — P. 1897-1899.

Bolddauf J., Oertel J., Gaab M.R. et al. endoscopic third ventriculostomy for occlusive hydrocephalus caused by cerebellar infarction // Neurosurgery. — 2006. — Vol. 59. — P. 539-544.

Виничук С.М., Пустовая О.А., Рогоза С.В., Виничук И.С. Острые спонтанные супратенториальные внутримозговые кровоизлияния. — К.: ПП Люкар, 2012.

Secades J.J., Lorenco J.L. Citicoline: pharmacological and clinical review, 2006 update // Methods Find. Exp. Clin. Pharmacol. — 2006. — Suppl. B. — P. 1956.

Adibhatla R.M., Hataher J.F. Lipid oxydation and peroxidation in CNS health and disease: from molecular mechanisms to therapeutic opportunites // Antiox. Redox Signal. — 2010. — Vol. 12, № 1. — P. 125-169.

Віничук С.М., Мохнач В.О., Прокопів М.М. та ін. Комплексна нейропротекція в гострий період ішемічного інсульту // Медицина неотложных состояний. — 2008. — № 4. — С. 53-59.




DOI: https://doi.org/10.22141/2224-0713.5.59.2013.85547

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 INTERNATIONAL NEUROLOGICAL JOURNAL

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

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru