Crossed cerebellar diaschisis

Case contributed by Dr Mauricio Macagnan

Presentation

Patient with a history of cerebral infarction. Currently has motor symptoms and limited mobility .

Patient Data

Age: 65 years
Gender: Female
MRI

Areas with low signal SWI compatible with hemorrhagic sequelae ( hemosiderin ), located in the left corona radiata and the insula, external capsule and lenticular nucleus, beyond the right amygdala and in the white matter of the temporal lobes .

Atrophy of the right cerebellar hemisphere, possibly related to crossed cerebellar diaschisis secondary to supratentorial injury.

Noareas of ischemic stroke in evolution on the DWI weighted sequences.

Diagram

The diagram shows cortico-ponto-cerebellar pathway, which due to supratentorial infarction has stopped and chronically determines contralateral cerebellar atrophy.

Case Discussion

In this condition , there is a decrease in functional activity and metabolism in the cerebellum contralateral supratentorial lesion.  This mechanism has been observed in cerebral ischemia patients , supratentorial tumors , epilepsy , encephalitis and some resulting in the disruption of the cortico-ponto-cerebellar pathway.

Functional studies through the use of CT , MRI and CT perfusion help the diagnosis.

This case was kindly provided by Dr Rodrigo Dias Duarte.

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