Cerebellar Stroke Research Articles

A case of vertebrobasilar dolichoectasia manifesting as sudden sensorineural hearing loss with vertigo

Vertebrobasilar dolichoectasia (VBD) is a rare vascular condition characterized by the elongation, widening, and tortuosity of the vertebrobasilar artery. It can lead to various symptoms due to compression of cranial nerves and brainstem structures. We report a rare case of VBD presenting as sudden sensorineural hearing loss (SSNHL) with vertigo and spontaneous downbeat nystagmus in a 65-year-old woman with a history of hypertension. Magnetic resonance imaging revealed a tortuous and dilated right vertebrobasilar artery compressing the brainstem and left 8th cranial nerve root entry zone, without signs of acute cerebellar stroke. The compression of the anterior inferior cerebellar artery and cervicomedullary junction was also noted, suggesting a vascular cause for her symptoms. Following high-dose steroid treatment, the patient showed significant hearing improvement. This case underscores the importance of considering VBD in patients with unexplained SSNHL and vertigo, highlighting the role of detailed vascular imaging in the diagnosis and management of such cases.

Bihormonal fully closed-loop system for the treatment of type 1 diabetes: a real-world multicentre, prospective, single-arm trial in the Netherlands

Management of insulin administration for intake of carbohydrates and physical activity can be burdensome for people with type 1 diabetes on hybrid closed-loop systems. Bihormonal fully closed-loop (FCL) systems could help reduce this burden. In this trial, we assessed the long-term performance and safety of a bihormonal FCL system. The FCL system (Inreda AP; Inreda Diabetic, Goor, Netherlands) that uses two hormones (insulin and glucagon) was assessed in a 1 year, multicentre, prospective, single-arm intervention trial in adults with type 1 diabetes. Participants were recruited in eight outpatient clinics in the Netherlands. We included adults with type 1 diabetes aged 18-75 years who had been using flash glucose monitoring or continuous glucose monitors for at least 3 months. Study visits were integrated into standard care, usually every three months, to evaluate glycaemic control, adverse events, and person-reported outcomes. The primary endpoint was time in range (TIR; glucose concentration 3·9-10·0 mmol/L) after 1 year. The study is registered in the Dutch Trial Register, NL9578. Between June 1, 2021, and March 2, 2022, we screened 90 individuals and enrolled 82 participants; 78 were included in the analyses. 79 started the intervention and 71 were included in the 12 month analysis. Mean age was 47.7 (SD 12·4) years and 38 (49%) were female participants. The mean preintervention TIR of participants was 55·5% (SD 17·2). After 1 year of FCL treatment, mean TIR was 80·3% (SD 5·4) and median time below range was 1·36% (IQR 0·80-2·11). Questionnaire scores improved on Problem Areas in Diabetes (PAID) from 30·0 (IQR 18·8-41·3) preintervention to 10·0 (IQR 3·8-21·3; p<0·0001) at 12 months and on World Health Organization-Five Well-Being Index (WHO-5) from 60·0 (IQR 44·0-72·0) preintervention to 76·0 (IQR 60·0-80·0; p<0·0001) at 12 months. Five serious adverse events were reported (one cerebellar stroke, two severe hypoglycaemic, and two hyperglycaemic events). Real-world data obtained in this trial demonstrate that use of the bihormonal FCL system was associated with good glycaemic control in patients who completed 1 year of treatment, and could help relieve these individuals with type 1 diabetes from making treatment decisions and the burden of carbohydrate counting. Inreda Diabetic.

Abstract TP84: Characteristics of Cerebellar Cognitive Affective Syndrome in Patients With Acute Cerebellar Stroke and Its Impact on Outcome

Background: Recently, cerebellar cognitive affective syndrome-scale (CCAS-S) was developed to assess CCAS in which cognitive impairment is caused by cerebellar lesions. However, very few studies have been conducted regarding CCAS in patients with stroke, and its impact on outcomes is unclear. This study aimed to evaluate CCAS in patients with acute cerebellar stroke and examine its association with outcome. Methods: Patients who experienced acute cerebellar stroke for the first time and were admitted to Steel Memorial Yawata Hospital, Japan within seven days of stroke onset between April 2021 and April 2023 were included in this observational study. CCAS-S, Mini-Mental State Examination (MMSE), and Scale for Assessment and Rating of Ataxia (SARA) scores were measured one week after stroke onset, and Functional Independence measure (FIM)/ Barthel Index (BI) at discharge, physical function, activities of daily living, length of hospital stay, and outcome (discharge destination) were evaluated. The Mann-Whitney U test was used to compare CCAS-S scores and other variables between patients with acute cerebellar stroke and healthy controls. Additionally, we compared these variables between patients discharged home and those discharged to a rehabilitation hospital. A significance level of less than 5%. Results: Thirteen consecutive patients with acute cerebellar stroke (9 women) and age-and sex-matched healthy controls (7 women) were included. The MMSE score was within the normal range in all patients; however, patients with stroke had a lower total CCAS-S score (median 72, interquartile range [IQR] 66-80) and a higher number of failed tests (median 4, IQR 3-5) than healthy controls. Significant deficits were observed in semantic fluency (p=0.008), category switching (p=0001), and similarity (p=009). Possible, probable, and definite CCAS were diagnosed in 2, 1, and 10 patients, respectively. Patients discharged home showed better SARA and FIM/BI scores but similar CCAS-S scores compared to those discharged to rehabilitation hospitals. Conclusion: CCAS along with impaired executive and language functions is frequently observed in patients with acute cerebellar stroke; however, impaired motor function, and not CCAS, influenced the outcome.

Cerebellar-Induced Aphasia After Stroke: Evidence for the “Linguistic Cerebellum”

The cerebellum is traditionally known to subserve motor functions. However, for several decades, the concept of the “cerebellar cognitive affective syndrome” has evolved. Studies in healthy participants and patients have confirmed the cerebellar role in language. The exact involvement of the cerebellum regarding cerebellar aphasia remains uncertain. We included 43 cerebellar stroke patients who were tested at 3 months post-onset with the Boston Naming Test (BNT), the Token Test (TT), and the Diagnostic Instrument for Mild Aphasia (DIMA). Lesion side (left/right) and volume (cm3) were investigated. Patients significantly deviated on the following: BNT (p<0.001), TT (p<0.05), DIMA subtests: sentences repetition (p=0.001), semantic odd-picture-out (p<0.05), sentence completion (p<0.05) without an effect of lesion location (left/right) or volume (cm3) (p>0.05). Our clinical study confirms a non-lateralized cerebellar aphasia post-stroke, characterized by impairments in word retrieval, phonology, semantics, and syntax resembling cerebral-induced aphasia. The integral cerebellum appears to interact with eloquent cortico-subcortical language areas.

Cardioembolic Stroke Due to Prosthetic Valve Endocarditis Caused by Candida parapsilosis: A Case Report

Embolic stroke due to prosthetic valve endocarditis (PVE) caused by Candida parapsilosis is a rare and serious complication. Successful management requires a combination of medical and surgical approaches. We present a case full of complexities in diagnosing and managing Candida PVE, emphasizing the importance of a multidisciplinary approach. A 50 year‐old male presented to the emergency department with vertigo and low‐grade fever and was found to have cerebellar stroke likely from the cardioembolic origin, and the patient had a history of uncontrolled diabetes and double prosthetic valves. The diagnosis was challenging and required transesophageal echocardiography (TEE) which showed two vegetations attached to the mitral valve prosthesis. The management involved antifungal therapy, but surgery was hindered by financial issues. The patient was considered for the AngioVac vegetation aspiration system due to persistent fungemia. Eventually, surgery was not performed, and the patient was discharged with a plan for long‐term suppressive antifungal therapy.

Acute Obstructive Hydrocephalus and Acute Cerebellar Ischemic Stroke as a Complication of Takayasu Arteritis in a Young Male Patient: A Rare Case Report

Introduction: Takayasu arteritis is a rare type of vasculitis associated with various neurological manifestations. Multiple components, including thrombosis, embolism, stenosis, and vascular inflammation, are involved in the underlying pathophysiology. Case Presentation: A 21-year-old male patient presented with vomiting, difficulty speaking, disorientation, and seizures. On examination, pinpoint pupils and blood pressure discrepancies among four limbs were noted. Imaging findings supported the diagnosis of acute obstructive hydrocephalus, acute cerebellar infarction, and Takayasu arteritis. The patient was treated with IV antibiotics and steroids and underwent a ventriculoperitoneal shunt. Case discussion: Takayasu arteritis with cerebellar ischemia and obstructive hydrocephalus is quite a rare case. It presents with headache, dizziness, disorientation, and rarely with stroke. The diagnostic process includes computed tomography angiography (CTA) and imaging of the brain. It is mostly treated with pharmacological therapy; however, in some cases, surgery is required. Conclusion: This case highlights the rare but serious neurological adverse effects of Takayasu arteritis in young male patients, as well as the importance of interdisciplinary care. To prevent neurological degeneration, Takayasu arteritis patients must be identified and treated as soon as possible.

Cerebellar stroke in a young female associated with elevated homocysteine levels and heterozygous MTHFR &lt;em style="mso-bidi-font-style: normal;"&gt;C677T&lt;/em&gt; gene:&amp;nbsp; A case report.

Homocysteine is an amino acid, which is an intermediate in the metabolism of methionine and cysteine. Elevated homocysteine levels are recognized as a cause for both arterial and venous thrombotic phenomena. Methylenetetrahydrofolatereductase -encoded by MTHFR gene- is the rate-limiting enzyme of the remethylation of homocysteine to methionine. Homozygous MTHFR T677T gene mutation can independently cause raised homocysteine levels and increase the risk of thrombosis whereas heterozygous MTHFR C677T gene mutation usually does with an acquired cause such as folate or vitamin B12 deficiency, and is with lesser risk for thrombosis. We report a case of a previously healthy 23-year-old female, who was excluded from other inherited and acquired thrombophilic conditions, but was found to be having heterozygous MTHFR C677T gene mutation and elevated level of homocysteine presented late with right cerebellar stroke. Therefore, when young patients present with thrombotic phenomena, homocysteine levels should be assessed in the absence of other common thrombophilic conditions.

Emotional dysmetria after cerebellar-pontine stroke: a case report

IntroductionPseudobulbar affect, or emotional dysregulation, commonly occurs following stroke. However, it is frequently missed in cases involving the cerebellum, resulting in a lack of treatment, which can directly impact stroke rehabilitation.Case presentationA 63-year-old Caucasian female with no history of mood disorders presented with gait instability, dysarthria, and right sided hemiplegia, secondary to cerebellar and pontine ischemic stroke from a basilar occlusion. She underwent endovascular therapy and her deficits gradually improved. However during recovery she began to develop uncontrollable tearfulness while retaining insight that her emotional expression was contextually inappropriate. She was treated with a selective serotonin reuptake inhibitor with reported improvements in her emotional regulation at one year follow up.ConclusionThis case highlights cerebellar injury as a potential cause of poorly regulated emotions, or an emotional dysmetria. The recognition of this disorder in patients with cerebellar or pontine strokes is critical, as untreated pseudobulbar affect can impact future stroke rehabilitation.

Dysphagia following cerebellar stroke: analyzing the contribution of the cerebellum to swallowing function.

Swallowing is essential for human health, and the cerebellum is crucial for motor movement regulation. Cerebellar strokes may cause dysphagia, but their exact effects remain unexplored in swallowing function. Therefore, the aim of this study was to analyze the precise clinical characteristics of the oral and pharyngeal phases of swallowing after cerebellar stroke and to critically discuss the cerebellum's contribution to swallowing. The study involved 34 participants with cerebellar strokes, gathered through convenience sampling. Neurologists diagnosed isolated strokes, and a speech and language pathologist examined swallowing ability using the Mann Assessment of Swallowing Ability. The study found that 52.9% of people experienced dysphagia after a cerebellar stroke. Dysphagia was significantly associated with a higher risk of aspiration. Age was also significantly correlated with dysphagia. No significant correlation was found between swallowing ability and sex. In conclusion, this study suggests isolated cerebellar stroke can adversely affect the motor and non-motor aspects of swallowing and cause severe dysphagia and aspiration risk. Thus, early diagnosis and timely management of dysphagia following a cerebellar stroke can help prevent serious consequences.

The CODECS study: COgnitive DEficits in Cerebellar Stroke

Part of the extra-pyramidal system, the cerebellum is more and more recognized by its non-motor functions known as the cerebellar cognitive affective syndrome. Several studies have identified disturbances specifically in executive and attentional functions after focal cerebellar lesions. However, most studies were performed in small and heterogeneous patient groups. Furthermore, there is a substantial variation in the methodology of assessment. Here, we present the results of a large and homogeneous cohort of patients with isolated uniform cerebellar lesions. After three months post-stroke all patients underwent structural neuroimaging to confirm an isolated lesion and were given neuropsychological testing. The results show that cerebellar lesions relate to mild but long-term cognitive impairment in a broad spectrum of neurocognitive functions compared to normative values. These findings confirm involvement of the cerebellum in cognitive processing and supports the theory of ‘dysmetria of thought’ based upon uniform cerebellar processing in multiple cognitive domains. This study highlights the following results: 1-Cognitive impairments after isolated cerebellar stroke is confirmed in several cognitive domains. 2-Semantic and phonemic fluency are most affected in cerebellar stroke patients. 3-Verbal deficits show an age-independent long term effect post-stroke and should be studied further in depth. 4-Cognitive disorders after cerebellar stroke are more prominent in women than men.

Baseline Factors Affecting the Prognosis of Ischemic Cerebellar Stroke Patients in Turkey: A Cross-Sectional Study.

Cerebellar infarcts are encountered commonly in clinical practice; however, they are likely to be misinterpreted. They cannot be adequately evaluated on scales such as the National Institute of Health Stroke Scale (NIHSS), which can have fatal consequences. To evaluate the baseline features, prognosis, and 6-month survival in patients with cerebellar stroke. A total of 200 patients with cerebellar ischemia were included in the study. Patients were analyzed retrospectively from 10 years of data. Both univariate and multivariate analyses were evaluated. Mean age was 68 years old, and men were more frequently affected. The most common symptoms were dysarthria and vertiginous sensations. Ischemic lesions were usually cortical/juxtacortical, multiple, hemispheric, and small (below 1.5 cm). The most commonly affected artery was the medial branch of the posterior inferior cerebellar artery. Cardioembolism was the more frequent etiology. Gait ataxia was associated with a more favorable prognosis and 6-month modified Rankin Scale (mRS) scores (OR: 0.15, 95% CI, P = 0.03). Older age (OR: 1.75, 95%, P = 0.02), female gender (OR: 6.72, 95%, P = 0.02), multiple (OR: 10.92, 95%, P = 0.01) and large lesions (OR: 6.56, 95% CI, P = 0.01), posterior circulation ischemic lesions extra-cerebellum (OR: 8.33, 95% CI, P = 0.01), left ventricular apical hypokinesia or AF (OR: 5.58, 95% CI, P = 0.02), and a high mRS score on admission (OR: 5.21, 95% CI, P < 0.001) was correlated with higher 6-month mRS and a lower survival rates. The study found that some baseline clinical, neurovascular imaging findings, and the mRS score on admission are useful predictors of cerebellar stroke prognosis and outcome.

Abstract 020: Undulating Flow Velocities as an Induced Test of Autoregulation After Thrombectomy for Acute Ischemic Stroke

Introduction Loss of autoregulation after endovascular therapy (EVT) for large‐artery acute ischemic stroke (AIS) is well documented. [1] This might result in worse outcomes, despite successful recanalization, from hyper‐ or hypoperfusion with a risk for hemorrhagic conversion or larger stroke volume, respectively. Transcranial doppler (TCD) was previously used to document this phenomenon using spontaneous fluctuations in reactivity. Herein, we present a patient with suspected obstructive sleep apnea (OSA) with undulating flow velocities on TCD, serving as a test for induced vasoreactivity with pre‐ and post‐EVT TCD. Methods A case‐report. Results A middle‐aged patient was admitted with acute left cerebellar stroke (figure 1A). An Embolic etiology was suspected and a 20‐minuteTCD was done for spontaneous emboli detection on bilateral middle cerebral arteries (MCA). The patient fell asleep during the study and it incidentally revealed a bilaterally symmetric undulating velocity, which is a pattern that was previously described with OSA as a result of vasomotor response to multiple apnea and hypopnea episodes occurring in succession (Figure 1D – Pre‐EVT). [2] This pattern indicates intact vasomotor reactivity to fluctuating O2 and CO2 levels during episodes of apnea. Six days later, the patient developed acute right MCA stroke (Figure 1B) and was treated with EVT with successful reperfusion (TICI 2B67) (Figure 1C). TCD was repeated after EVT, and the previously seen undulating pattern was lost with significantly reduced variability on the right MCA compared to the contralateral side (figure 1E – Post‐EVT). This indicates a significant reduction in vasomotor reactivity and autoregulatory capacity of the right MCA. Follow up imaging revealed hemorrhagic conversion in the bed of the stroke with intraparenchymal bleeding (PH1) (Figures 1F‐H). This case is unique since it provides an induced test of autoregulation and compares pre‐ and post‐EVT autoregulatory function. Prior reports did not use any stressors to test for autoregulation. While in this case, apnea served as a natural test for autoregulation allowing for easier detection. This can serve as a future marker that can be easily quantified and might guide post‐EVT care. Using breath holding maneuvers or medication (e.g., Acetazolamide) might be considered in the future to quantify the autoregulatory response. Further studies are required to investigate the utility of induced, instead of spontaneous, autoregulation assessment post‐EVT to guide blood pressure goals and the duration of strict blood pressure control after endovascular intervention. Conclusion Induced tests for autoregulation using TCD might be feasible and should be considered in the future as an easy method for quantifying autoregulation post‐EVT. Further studies are required to clarify the utility of this biomarker in guiding post‐EVT care.

Injury of the Vestibulocerebellar Tract and Signs of Ataxia in Patients with Cerebellar Stroke

Background: The vestibulocerebellar tract (VCT) is responsible for maintaining balance, spatial orientation, and coordination. Damage to the vestibular system is accompanied by symptoms of balance disorder or ataxia. This study aimed to compare cerebellar dysfunction according to VCT damage in patients with cerebellar stroke. Methods: Six patients with cerebellum injury were recruited. This study measured ataxia and hand function related to visuomotor integration and manual dexterity using the Purdue pegboard test. The primary and bilateral secondary VCTs were reconstructed to investigate the integrity of pathways using diffusion tensor imaging (DTI). Results: The ataxia sign was positive in five patients (83%) at onset. In the result of the pegboard test, all patients had hand dysfunction in the dominant hand (100%). Likewise, all patients also had non-dominant hand dysfunction (100%). On the DTI tractography, the left and right primary VCTs of the patients demonstrated a 25% injury rate. Furthermore, the injury rates of ipsilateral and contralateral secondary VCTs were 50% and 58%. Conclusions: Ataxia is related to secondary VCTs, and hand dysfunction is also related to VCTs. Therefore, we believe that the current study will be helpful in evaluating and providing a clinical intervention strategy for patients with ataxia and hand dysfunction following cerebellar injury.

Cerebellar Infarction from a Vertebral Artery Dissection after Blunt Chest Injury: A Case Report.

Traumatic vertebral artery dissections resulting in stroke are relatively rare occurrences, especially in the absence of classic physical examination findings. We present the case of a 30-year-old male with chest pain following a car axle falling onto his chest while trying to change a tire. He was discharged from the emergency department after having a negative workup for thoracic injury. Six hours later, the patient returned with headache and was found to have a cerebellar stroke secondary to vertebral artery dissection. After hospitalization, the patient was discharged home without any neurological deficits. As they are usually asymptomatic, up to 80% of patients with blunt cerebrovascular injury will have delayed or missed diagnoses. Given the increased awareness of vascular injuries and their high morbidity, physicians should maintain a high index of suspicion for this diagnosis.

Frailty in cerebellar ischemic stroke-The significance of temporal muscle thickness.

While comprising only 2% of all ischemic strokes, cerebellar strokes are responsible for substantial morbidity and mortality due to their subtle initial presentation and the morbidity of posterior fossa swelling. Furthermore, low temporal muscle thickness (TMT) has recently been identified as a prognostic imaging parameter to assess patient frailty and outcome. We analyzed radiological and clinical data sets of 282 patients with cerebellar ischemic stroke. Our analysis showed a significant association between low TMT, reduced NIHSS and mRS at discharge (p = 0.035, p = 0.004), and reduced mRS at 12 months (p = 0.001). TMT may be used as a prognostic imaging marker and objective tool to assess outcomes in patients with cerebellar ischemic stroke.

Gait disorders induced by photothrombotic cerebellar stroke in mice

Patients with cerebellar stroke display relatively mild ataxic gaits. These motor deficits often improve dramatically; however, the neural mechanisms of this improvement have yet to be elucidated. Previous studies in mouse models of gait ataxia, such as ho15J mice and cbln1-null mice, have shown that they have a dysfunction of parallel fiber-Purkinje cell synapses in the cerebellum. However, the effects of cerebellar stroke on the locomotor kinematics of wild-type mice are currently unknown. Here, we performed a kinematic analysis of gait ataxia caused by a photothrombotic stroke in the medial, vermal, and intermediate regions of the cerebellum of wild-type mice. We used the data and observations from this analysis to develop a model that will allow locomotive prognosis and indicate potential treatment regimens following a cerebellar stroke. Our analysis showed that mice performed poorly in a ladder rung test after a stroke. During walking on a treadmill, the mice with induced cerebellar stroke had an increased duty ratio of the hindlimb caused by shortened duration of the swing phase. Overall, our findings suggest that photothrombotic cerebellar infarction and kinematic gait analyses will provide a useful model for quantification of different types of acute management of cerebellar stroke in rodents.

Case Report: Cerebellar Stroke with Acute Vestibular Syndrome

The posterior circulation accounts for around 20% of cerebral ischemic strokes. According to estimates, 20% of these individuals appear with solitary vertigo. This symptom is incorrectly classified as peripheral vestibular in roughly one-sixth to one-third of these patients [1]. As a result, therapeutic and secondary preventive treatment is deferred from these missing stroke patients, potentially resulting in avoidable morbidity and mortality. Based on a careful evaluation of the literature, we suggest a diagnostic method for clinical differentiating of individuals with acute vestibular syndrome [2]. A stroke involving the inferior cerebellum must be recognized because it can cause cerebellar enlargement, which can lead to brain stem compression and death unless surgery is performed [1]. We report a case of 45-year-old female who had vertigo for 4-5 months and it is not associated with vomiting and posture or climate change, imbalance while walking for 6 months. She is known case of diabetes for 2 years with ongoing Antidiabetic treatment. Evaluating a central origin vertigo or dizziness is the main consequence here.

Poster Session: Reaching Accuracy Assessment in Cerebellar Stroke using Virtual Reality.

To investigate the application of virtual reality (VR) in the rapid quantification of reaching accuracy at the bedside for patients with cerebellar stroke (CS). Dysmetria, the inability to measure distance in muscular tasks correctly, is a common clinical feature of cerebellar injury. Objective quantification of reaching accuracy for clinical assessment is lacking, and the emerging VR technology with hand-tracking offers a promising opportunity to examine the speed, accuracy, and consistency of hand movements and proprioceptive function. 29 individuals (10 CS patients and 19 age-matched not-disabled controls) performed a task measuring reaching accuracy on the VR headset (Oculus Quest 2). 50% of the trials displayed a visible rendering of the hand (visible hand condition), and 50% did not (invisible hand condition). Reaching error was higher in CS compared to age-matched controls in both visible and invisible hand conditions. Reaching error was higher in the invisible hand condition compared to the visible hand condition in healthy controls, right CS, left CS but not in bilateral CS patients. The average time per trial was higher in patients than in controls. VR technology promises to be a non-invasive and rapid approach to quantifying fine motor functions in clinical settings. Further studies are needed to examine quantitative changes in reaching accuracy during post-stroke progression.

Assessment and recovery of visually guided reaching deficits following cerebellar stroke.

The cerebellum is known to play an important role in the coordination and timing of limb movements. The present study focused on how reach kinematics are affected by cerebellar lesions to quantify both the presence of motor impairment, and recovery of motor function over time. In the current study, 12 patients with isolated cerebellar stroke completed clinical measures of cognitive and motor function, as well as a visually guided reaching (VGR) task using the Kinarm exoskeleton at baseline (∼2 weeks), as well as 6, 12, and 24-weeks post-stroke. During the VGR task, patients made unassisted reaches with visual feedback from a central ‘start’ position to one of eight targets arranged in a circle. At baseline, 6/12 patients were impaired across several parameters of the VGR task compared to a Kinarm normative sample (n = 307), revealing deficits in both feed-forward and feedback control. The only clinical measures that consistently demonstrated impairment were the Purdue Pegboard Task (PPT; 9/12 patients) and the Montreal Cognitive Assessment (6/11 patients). Overall, patients who were impaired at baseline showed significant recovery by the 24-week follow-up for both VGR and the PPT. A lesion overlap analysis indicated that the regions most commonly damaged in 5/12 patients (42% overlap) were lobule IX and Crus II of the right cerebellum. A lesion subtraction analysis comparing patients who were impaired (n = 6) vs. unimpaired (n = 6) on the VGR task at baseline showed that the region most commonly damaged in impaired patients was lobule VIII of the right cerebellum (40% overlap). Our results lend further support to the notion that the cerebellum is involved in both feedforward and feedback control during reaching, and that cerebellar patients tend to recover relatively quickly overall. In addition, we argue that future research should study the effects of cerebellar damage on visuomotor control from a perception-action theoretical framework to better understand how the cerebellum works with the dorsal stream to control visually guided action.

Characteristics of post-stroke dysphagia: A retrospective study based on FEES.

This study aims to examine the characteristics of dysphagia in stroke patients with different lesion sites and explore the factors that impact the duration of nasogastric tube after post-stroke dysphagia (PSD). Patients with PSD were screened for analysis. Stroke types and lesion sites were confirmed using MRI or CT scans. Included patients were categorized into two groups: supratentorial stroke group (including lobar and deep intracerebral stroke subgroups) and infratentorial stroke group (including brainstem and cerebellar stroke subgroups). Fiberoptic endoscopic evaluation of swallowing (FEES), Penetration-aspiration scale (PAS), Yale pharyngeal residue (PR) severity rating scale, Functional oral intake scale (FOIS), Murray secretion severity rating scale (MSS), laryngopharyngeal sensation, and vocal fold mobility were investigated to assess the swallowing function. A total of 94 patients were included in the final analysis. Significant differences were found in PR scores (p<.001), PAS scores (p<.05), MSS scores (p<.05), and vocal fold mobility (p<.001) between infratentorial and supratentorial stroke groups. Moreover, lobar stroke showed significantly higher PR scores compared to the deep intracerebral stroke group (p<.05). Kaplan-Meier survival analysis indicated significant differences in the duration of nasogastric tube placement among the following groups: infratentorial versus supratentorial stroke, PAS ≤ 5versus PAS>5, PR ≥ 3versus PR<3, and normal vocal fold mobility versus vocal fold motion impairment group (p<.05). The infratentorial stroke may lead to worse swallowing function as compared to a supratentorial stroke. Additionally, patients with infratentorial stroke, PAS>5, PR ≥ 3, or vocal fold motion impairment may contribute to a longer duration of nasogastric tube placement.