Crossed cerebellar diaschisis in a case of Rasmussen encephalitis
Known history of Rasmussen encephalitis diagnosed 10 years ago presented with seizures. The patient was born full term and had a normal childhood until the age of 10 when seizures started. There is a moderate left hemiparesis. No cognitive impairment.
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MR demonstrates diffuse right cerebral hemiatrophy with encephalomalacia and gliotic changes involving the whole hemisphere. There is also severe ex vacuo dilatation of the right lateral ventricle. Reduction in volume of the ipsilateral cerebral peduncle due to Wallerian degeneration.
There is also contralateral cerebellar hemiatrophy and gliosis with atrophy of the left middle cerebellar peduncle was noted.
Diaschisis refers to a depression of metabolism affecting the cerebellar hemisphere, as a result of a contralateral supratentorial damage caused by interruption of cortico-ponto-cerebellar tracts.