Crossed cerebellar diaschisis
Crossed cerebellar diaschisis (CCD) refers to a depression of blood flow and metabolism affecting a cerebellar hemisphere occurring as a result of a contralateral focal supratentorial lesion, classically an infarct.
Other than neurological deficits and other clinical features associated with the contralateral supratentorial lesion, this condition is generally asymptomatic 1.
Diaschisis in the brain, by definition, refers to an acute inhibition of function and metabolism produced by a focal disturbance in a portion of the brain at a distance from the original site of injury but connected via white matter tracts 1. Although initially defined as caused by an acute lesion, many sources in the literature employ a more liberal definition and refer to it being related to a lesion of any temporal duration 1.
When affecting the cerebellum, it is a well-recognised phenomenon following cerebral infarction 2-4, although it can be a sequela of any significant supratenoral lesion (e.g. tumours 1, intracerebral haemorrhage 5, encephalitis 5, Dyke-Davidoff-Masson syndrome 6, radiation necrosis, etc.). The most likely mechanism is thought to be interruption of cortico-ponto-cerebellar white matter tracts, which then results in deafferentation and hypometabolism of the contralateral cerebellar hemisphere 2.
By definition, nuclear medicine should be performed to formally detect hypometabolism in the contralateral cerebellar hemisphere 1, however other imaging modalities may be useful if interpreted in the correct clinical context.
CT / MRI and CT perfusion
CT perfusion performed during an acute stroke may show a contralateral perfusion abnormality in about 20% of cases 4. In particular, CBF and CBV maps show only mild-to-moderate reduction in these parameters, which are not low enough to classify as infarctions 7. MR perfusion can also play a similar role 3,4. In chronic stages, there can be associated volume loss to the contralateral cerebellar hemisphere, known as crossed cerebellar atrophy 1,2.
FDG PET shows hypometabolism in affected cerebellar hemisphere, which is diagnostic of this condition 1.
- 1. Tien RD, Ashdown BC. Crossed cerebellar diaschisis and crossed cerebellar atrophy: correlation of MR findings, clinical symptoms, and supratentorial diseases in 26 patients. AJR Am J Roentgenol. 1992;158 (5): 1155-9. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Infeld B, Davis SM, Lichtenstein M et-al. Crossed cerebellar diaschisis and brain recovery after stroke. Stroke. 1995;26 (1): 90-5. Stroke (link) - Pubmed citation
- 3. Lin DD, Kleinman JT, Wityk RJ et-al. Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging. AJNR Am J Neuroradiol. 2009;30 (4): 710-5. doi:10.3174/ajnr.A1435 - Free text at pubmed - Pubmed citation
- 4. Förster A, Kerl HU, Goerlitz J et-al. Crossed cerebellar diaschisis in acute isolated thalamic infarction detected by dynamic susceptibility contrast perfusion MRI. PLoS ONE. 2014;9 (2): e88044. doi:10.1371/journal.pone.0088044 - Free text at pubmed - Pubmed citation
- 5. Jiménez-Caballero PE. Crossed cerebellar atrophy: Update. Journal of neurosciences in rural practice. 3 (3): 235-6. doi:10.4103/0976-3147.102588 - Pubmed
- 6. Demir Y, Sürücü E, Çilingir V, Bulut MD, Tombul T. Dyke-Davidoff-Masson Syndrome With Cerebral Hypometabolism and Unique Crossed Cerebellar Diaschisis in 18F-FDG PET/CT. Clinical nuclear medicine. 40 (9): 757-8. doi:10.1097/RLU.0000000000000890 - Pubmed
- 7. Jeon YW, Kim SH, Lee JY, Whang K, Kim MS, Kim YJ, Lee MS. Dynamic CT perfusion imaging for the detection of crossed cerebellar diaschisis in acute ischemic stroke. Korean journal of radiology. 13 (1): 12-9. doi:10.3348/kjr.2012.13.1.12 - Pubmed