Abstract
Crossed cerebellar diaschisis (CCD) is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to the supratentorial focal lesion. The phenomenon termed parakinesia brachialis oscitans (PBO) in which stroke patients experience involuntary stretching of the hemiplegic arm during yawning is rarely reported. The concurrence of CCD and PBO has never been described. A 52-year-old man had putaminal hemorrhage and demonstrated no significant recovery in his left hemiplegia after intensive rehabilitation, but his gait improved gradually. Two months after the stroke, the single photon emission computed tomography (SPECT) showed CCD. Four months after the stroke, the patient noticed PBO. The follow-up SPECT showed persistent CCD and the patient's arm was still plegic. The frequency and intensity of PBO have increased with time since the stroke. We speculate that the two phenomena CCD and PBO might share similar neuroanatomical pathways and be valuable for predicting clinical recovery after stroke.
Highlights
Crossed cerebellar diaschisis (CCD) is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to a supratentorial focal lesion such as a cerebral infarction or hematoma
Less attention has been paid to the phenomenon termed parakinesia brachialis oscitans (PBO) in which stroke patients experience involuntary stretching of the hemiplegic arm upon yawning [2]
We report the case of a stroke patient with putaminal hemorrhage presenting with concurrent CCD and PBO and discuss their common anatomic pathway and the effects of these conditions on clinical outcome
Summary
Crossed cerebellar diaschisis (CCD) is defined as a reduction in blood flow in the cerebellar hemisphere contralateral to a supratentorial focal lesion such as a cerebral infarction or hematoma. CCD occurs in more than 50% of patients with supratentorial focal lesions. Few articles have described CCD due to a subcortical hemorrhage [1]. The anatomical pathways involved in this involuntary motor response are yet to be fully clarified, and the prevalence of PBO is rarely reported. The concurrence of PBO and CCD has never been described. We report the case of a stroke patient with putaminal hemorrhage presenting with concurrent CCD and PBO and discuss their common anatomic pathway and the effects of these conditions on clinical outcome
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