Abstract
PurposeCrossed cerebellar diaschisis (CCD) is a state of neural depression caused by loss of connections to injured neural structures remote from the cerebellum usually evaluated by positron emission tomography. Recently it has been shown that dynamic susceptibility contrast perfusion weighted MRI (PWI) may also be feasible to detect the phenomenon. In this study we aimed to assess the frequency of CCD on PWI in patients with acute thalamic infarction.MethodsFrom a MRI report database we identified patients with acute isolated thalamic infarction. Contralateral cerebellar hypoperfusion was identified by inspection of time to peak (TTP) maps and evaluated quantitatively on TTP, mean transit time (MTT), cerebral blood flow and volume (CBF, CBV) maps. A competing cerebellar pathology or an underlying vascular pathology were excluded.ResultsA total of 39 patients was included. Common symptoms were hemiparesis (53.8%), hemihypaesthesia (38.5%), dysarthria (30.8%), aphasia (17.9%), and ataxia (15.4%). In 9 patients (23.1%) PWI showed hypoperfusion in the contralateral cerebellar hemisphere. All of these had lesions in the territory of the tuberothalamic, paramedian, or inferolateral arteries. Dysarthria was observed more frequently in patients with CCD (6/9 vs. 6/30; OR 8.00; 95%CI 1.54–41.64, p = 0.01). In patients with CCD, the median ischemic lesion volume on DWI (0.91 cm3, IQR 0.49–1.54 cm3) was larger compared to patients with unremarkable PWI (0.51 cm3, IQR 0.32–0.74, p = 0.05). The most pronounced changes were found in CBF (0.94±0.11) and MTT (1.06±0.13) signal ratios, followed by TTP (1.05±0.02).ConclusionsMultimodal MRI demonstrates CCD in about 20% of acute isolated thalamic infarction patients. Lesion size seems to be a relevant factor in its pathophysiology.
Highlights
At the beginning of the 20th century the term ‘‘diaschisis’’ was introduced by the russian neurologist and neuropathologist Constantin von Monakow to describe a state of neural depression in the brain caused by loss of connections to injured neural structures remote from the affected brain area [1]
The arterial blood supply of the thalamus can be subdivided into four major vascular territories: (1) the tuberothalamic artery emanating from the posterior communicating artery (PComA), (2) the paramedian arteries arising from the P1 segment of the posterior cerebral artery (PCA) as well as (3) the inferolateral arteries and (4) the lateral and medial branches of the posterior choroidal artery, from the P2 segment of the PCA [16]
From a prospectively maintained MRI report database (Syngo Data Manager – SDM), we identified 698 patients with suspected acute ischemic stroke who underwent a standard stroke MRI protocol including perfusion weighted MRI (PWI) (2005–2013)
Summary
At the beginning of the 20th century the term ‘‘diaschisis’’ was introduced by the russian neurologist and neuropathologist Constantin von Monakow to describe a state of neural depression in the brain caused by loss of connections to injured neural structures remote from the affected brain area [1]. The pathophysiological concept of diaschisis is nowadays widely accepted and many articles concerning different aspects of this phenomenon have been published [2,3] In most of these studies positron emission tomography (PET) has been used to demonstrate a hypometabolism or hypoperfusion in brain areas distant from the actual lesion like the ipsilateral cerebral cortex [4,5] or the contralateral cerebellum [6,7,8,9,10]. Thalamogeniculate arteries) and (4) the lateral and medial branches of the posterior choroidal artery, from the P2 segment of the PCA [16] Infarctions in these distinct vascular territories can be found in varying frequency and are associated with typical, well-defined clinical syndromes [16,17]
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