Skip to main content
Top
Published in: Japanese Journal of Radiology 2/2020

01-02-2020 | Magnetic Resonance Imaging | Original Article

Characteristics of cerebral perfusion and diffusion associated with crossed cerebellar diaschisis after acute ischemic stroke

Authors: Miao Zhang, Yanxiang Cao, Fang Wu, Cheng Zhao, Qingfeng Ma, Kuncheng Li, Jie Lu

Published in: Japanese Journal of Radiology | Issue 2/2020

Login to get access

Abstract

Purpose

We aimed to investigate the possible factors associated with the occurrence of crossed cerebellar diaschisis (CCD) at the hyperacute stage of ischemic stroke using whole-brain volume perfusion CT (VPCT) combined with magnetic resonance imaging (MRI).

Materials and methods

We retrospectively analyzed 108 patients with ischemic stroke within 6 h of onset. The VPCT findings of the patients showed a unilateral perfusion deficit in the supratentorial territory. Follow-up MRI examinations were performed within 24 h after onset. The effects of the supratentorial cerebral ischemia, the location distribution, the final infarct volume and the apparent diffusion coefficient (ADC) value on the occurrence and severity of CCD were analyzed.

Results

Among 108 patients with hyperacute cerebral ischemia, 62 (57.4%) demonstrated a contralateral cerebellar perfusion deficit on the VPCT maps. The occurrence of CCD was related to a reduction in cerebral blood volume (CBV) and prolongation of the mean transit time (MTT). Notably, the decrease in the ADC value in the infarct based on follow-up MRI was closely related to the occurrence and severity of CCD.

Conclusion

The occurrence and severity of CCD are related to the degree of low supratentorial perfusion and the decrease in the ADC value of infarct focus.
Literature
1.
go back to reference Komaba Y, Mishina M, Utsumi K, Katayama Y, Kobayashi S, Mori O. Crossed cerebellar diaschisis in patients with cortical infarction: logistic regression analysis to control for confounding effects. Stroke. 2004;35:472–6.CrossRef Komaba Y, Mishina M, Utsumi K, Katayama Y, Kobayashi S, Mori O. Crossed cerebellar diaschisis in patients with cortical infarction: logistic regression analysis to control for confounding effects. Stroke. 2004;35:472–6.CrossRef
2.
go back to reference Baron JC, Bousser MG, Comar D, Castaigne P. “Crossed cerebellar diaschisis” in human supratentorial brain infarction. Trans Am Neurol Assoc. 1981;105:459–61.PubMed Baron JC, Bousser MG, Comar D, Castaigne P. “Crossed cerebellar diaschisis” in human supratentorial brain infarction. Trans Am Neurol Assoc. 1981;105:459–61.PubMed
3.
go back to reference Ito H, Kanno I, Shimosegawa E, Tamura H, Okane K, Hatazawa J. Hemodynamic changes during neural deactivation in human brain: a positron emission tomography study of crossed cerebellar diaschisis. Ann Nucl Med. 2002;16:249–54.CrossRef Ito H, Kanno I, Shimosegawa E, Tamura H, Okane K, Hatazawa J. Hemodynamic changes during neural deactivation in human brain: a positron emission tomography study of crossed cerebellar diaschisis. Ann Nucl Med. 2002;16:249–54.CrossRef
4.
go back to reference Sagiuchi T, Ishii K, Asano Y, Aoki Y, Kikuchi K, Jinguuji K, et al. Interictal crossed cerebellar hyperperfusion on Tc-99 m ECD SPECT. Ann Nucl Med. 2001;15:369–72.CrossRef Sagiuchi T, Ishii K, Asano Y, Aoki Y, Kikuchi K, Jinguuji K, et al. Interictal crossed cerebellar hyperperfusion on Tc-99 m ECD SPECT. Ann Nucl Med. 2001;15:369–72.CrossRef
5.
go back to reference Miyazaki D, Fukushima K, Nakahara A, Kodaira M, Mochizuki K, Kaneko K, et al. Crossed cerebellar diaschisis in status epilepticus. Intern Med. 2015;55:1649–51.CrossRef Miyazaki D, Fukushima K, Nakahara A, Kodaira M, Mochizuki K, Kaneko K, et al. Crossed cerebellar diaschisis in status epilepticus. Intern Med. 2015;55:1649–51.CrossRef
6.
go back to reference Niimura K, Chugani DC, Muzik O, Chugani HT. Cerebellar reorganization following cortical injury in humans: effects of lesion size and age. Neurology. 1999;52:792–7.CrossRef Niimura K, Chugani DC, Muzik O, Chugani HT. Cerebellar reorganization following cortical injury in humans: effects of lesion size and age. Neurology. 1999;52:792–7.CrossRef
7.
go back to reference Otte A, Roelcke U, von Ammon K, Hausmann O, Maguire RP, Missimer J, et al. Crossed cerebellar diaschisis and brain tumor biochemistry studied with positron emission tomography, [F-18] fluorodeoxyglucose and [C-11] methionine. J Neurol Sci. 1998;156:73–7.CrossRef Otte A, Roelcke U, von Ammon K, Hausmann O, Maguire RP, Missimer J, et al. Crossed cerebellar diaschisis and brain tumor biochemistry studied with positron emission tomography, [F-18] fluorodeoxyglucose and [C-11] methionine. J Neurol Sci. 1998;156:73–7.CrossRef
8.
go back to reference Soria N, Meli F, Blumenkrantz Y, Salas E, Turjanski A. Crossed cerebellar diaschisis.study of a patient by magnetic resonance imaging and positron emission tomography. Rev Neurol. 2013;56:425–8.PubMed Soria N, Meli F, Blumenkrantz Y, Salas E, Turjanski A. Crossed cerebellar diaschisis.study of a patient by magnetic resonance imaging and positron emission tomography. Rev Neurol. 2013;56:425–8.PubMed
9.
go back to reference Takasawa M, Watanabe M, Yamamoto S, et al. Prognostic value of subacute crossed cerebellar diaschisis: single-photon emission CT study in patients with middle cerebral artery territory infarct. Am J Neuroradiol. 2002;23:189–93.PubMed Takasawa M, Watanabe M, Yamamoto S, et al. Prognostic value of subacute crossed cerebellar diaschisis: single-photon emission CT study in patients with middle cerebral artery territory infarct. Am J Neuroradiol. 2002;23:189–93.PubMed
10.
go back to reference Flint AC, Naley MC, Wright CB. Ataxic hemiparesis from strategic frontal white matter infarction with crossed cerebellar diaschisis. Stroke. 2006;37:e1–2.CrossRef Flint AC, Naley MC, Wright CB. Ataxic hemiparesis from strategic frontal white matter infarction with crossed cerebellar diaschisis. Stroke. 2006;37:e1–2.CrossRef
11.
go back to reference Fu J, Chen WJ, Wu GY, Cheng JL, Wang MH, Zhuge Q, et al. Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage. Neuroradiology. 2015;57:179–87.CrossRef Fu J, Chen WJ, Wu GY, Cheng JL, Wang MH, Zhuge Q, et al. Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage. Neuroradiology. 2015;57:179–87.CrossRef
12.
go back to reference Szilágyi G, Vas A, Kerényi L, Nagy Z, Csiba L, Gulyás B. Correlation between crossed cerebellar diaschisis and clinical neurological scales. Acta Neurol Scand. 2012;125:373–81.CrossRef Szilágyi G, Vas A, Kerényi L, Nagy Z, Csiba L, Gulyás B. Correlation between crossed cerebellar diaschisis and clinical neurological scales. Acta Neurol Scand. 2012;125:373–81.CrossRef
13.
go back to reference Lin DD, Kleinman JT, Wityk RJ, Gottesman RF, Hillis AE, Lee AW, et al. Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging. Am J Neuroradiol. 2009;30:710–5.CrossRef Lin DD, Kleinman JT, Wityk RJ, Gottesman RF, Hillis AE, Lee AW, et al. Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging. Am J Neuroradiol. 2009;30:710–5.CrossRef
14.
go back to reference Chen S, Guan M, Lian HJ, Ma LJ, Shang JK, He S, et al. Crossed cerebellar diaschisis detected by arterial spin-labeled perfusion magnetic resonance imaging in subacute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23:2378–83.CrossRef Chen S, Guan M, Lian HJ, Ma LJ, Shang JK, He S, et al. Crossed cerebellar diaschisis detected by arterial spin-labeled perfusion magnetic resonance imaging in subacute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23:2378–83.CrossRef
15.
go back to reference Kang KM, Sohn CH, Kim BS, Kim YI, Choi SH, Yun TJ, et al. Correlation of asymmetry indices measured by arterial spin-labeling mr imaging and spect in patients with crossed cerebellar diaschisis. Am J Neuroradiol. 2015;36:1662–8.CrossRef Kang KM, Sohn CH, Kim BS, Kim YI, Choi SH, Yun TJ, et al. Correlation of asymmetry indices measured by arterial spin-labeling mr imaging and spect in patients with crossed cerebellar diaschisis. Am J Neuroradiol. 2015;36:1662–8.CrossRef
16.
go back to reference Strother MK, Buckingham C, Faraco CC, Arteaga DF, Lu P, Xu Y, et al. Crossed cerebellar diaschisis after stroke identified noninvasively with cerebral blood flow-weighted arterial spin labeling MRI. Eur J Radiol. 2016;85:136–42.CrossRef Strother MK, Buckingham C, Faraco CC, Arteaga DF, Lu P, Xu Y, et al. Crossed cerebellar diaschisis after stroke identified noninvasively with cerebral blood flow-weighted arterial spin labeling MRI. Eur J Radiol. 2016;85:136–42.CrossRef
17.
go back to reference Jeon YW, Kim SH, Lee JY, Whang K, Kim MS, Kim YJ, et al. Dynamic CT perfusion imaging for the detection of crossed cerebellar diaschisis in acute ischemic stroke. Korean J Radiol. 2012;13:12–9.CrossRef Jeon YW, Kim SH, Lee JY, Whang K, Kim MS, Kim YJ, et al. Dynamic CT perfusion imaging for the detection of crossed cerebellar diaschisis in acute ischemic stroke. Korean J Radiol. 2012;13:12–9.CrossRef
18.
go back to reference Biaou O, Abderahim R, Soto Ares G, Jissendi Tchofo P. Crossed cerebellar diaschisis post status epilepticus. J Radiol. 2008;89:507–9.CrossRef Biaou O, Abderahim R, Soto Ares G, Jissendi Tchofo P. Crossed cerebellar diaschisis post status epilepticus. J Radiol. 2008;89:507–9.CrossRef
19.
go back to reference Ribeiro M, Beleza P, Fernandes J, Almeida F, Rocha J. Reverse crossed cerebellar diaschisis. Acta Med Port. 2006;19:439–41.PubMed Ribeiro M, Beleza P, Fernandes J, Almeida F, Rocha J. Reverse crossed cerebellar diaschisis. Acta Med Port. 2006;19:439–41.PubMed
20.
go back to reference Dodick DW, Roarke MC. Crossed cerebellar diaschisis during migraine with prolonged aura: a possible mechanism for cerebellar infarctions. Cephalalgia. 2008;28:83–6.CrossRef Dodick DW, Roarke MC. Crossed cerebellar diaschisis during migraine with prolonged aura: a possible mechanism for cerebellar infarctions. Cephalalgia. 2008;28:83–6.CrossRef
21.
go back to reference Kunz WG, Sommer WH, Höhne C, Fabritius MP, Schuler F, Dorn F, et al. Crossed cerebellar diaschisis in acute ischemic stroke: impact on morphologic and functional outcome. J Cereb Blood Flow Metab. 2017;37:3615–24.CrossRef Kunz WG, Sommer WH, Höhne C, Fabritius MP, Schuler F, Dorn F, et al. Crossed cerebellar diaschisis in acute ischemic stroke: impact on morphologic and functional outcome. J Cereb Blood Flow Metab. 2017;37:3615–24.CrossRef
22.
go back to reference Sommer WH, Bollwein C, Thierfelder KM, Baumann A, Janssen H, Ertl-Wagner B, et al. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: occurrence and perfusion characteristics. J Cereb Blood Flow Metab. 2016;36:743–54.CrossRef Sommer WH, Bollwein C, Thierfelder KM, Baumann A, Janssen H, Ertl-Wagner B, et al. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: occurrence and perfusion characteristics. J Cereb Blood Flow Metab. 2016;36:743–54.CrossRef
23.
go back to reference Liu J, Li J, Yang Y, Wang X, Zhang Z, Zhang L. Neuronal apoptosis in cerebral ischemia/reperfusion area following electrical stimulation of fastigial nucleus. Neural Regen Res. 2014;9:727–34.CrossRef Liu J, Li J, Yang Y, Wang X, Zhang Z, Zhang L. Neuronal apoptosis in cerebral ischemia/reperfusion area following electrical stimulation of fastigial nucleus. Neural Regen Res. 2014;9:727–34.CrossRef
24.
go back to reference Nocuń A, Wojczal J, Szczepańska-Szerej H, Wilczyński M, Chrapko B. Quantitative evaluation of crossed cerebellar diaschisis, using voxel-based analysis of Tc-99 m ECD brain SPECT. Nucl Med Rev Cent East Eur. 2013;16:31–4.CrossRef Nocuń A, Wojczal J, Szczepańska-Szerej H, Wilczyński M, Chrapko B. Quantitative evaluation of crossed cerebellar diaschisis, using voxel-based analysis of Tc-99 m ECD brain SPECT. Nucl Med Rev Cent East Eur. 2013;16:31–4.CrossRef
25.
go back to reference Gharbawie OA, Whishaw IQ. Parallel stages of learning and recovery of skilled reaching after motor cortex stroke : “oppositions”organize normal and compensatory movements. Behav Brain Res. 2006;175:249–62.CrossRef Gharbawie OA, Whishaw IQ. Parallel stages of learning and recovery of skilled reaching after motor cortex stroke : “oppositions”organize normal and compensatory movements. Behav Brain Res. 2006;175:249–62.CrossRef
26.
go back to reference Kim SE, Choi CW, Yoon BW, Chung JK, Roh JH, Lee MC, et al. Crossed-cerebellar diaschisis in cerebral infarction: technetium-99 m-HMPAO SPECT and MRI. J Nucl Med. 1997;38:14–9.PubMed Kim SE, Choi CW, Yoon BW, Chung JK, Roh JH, Lee MC, et al. Crossed-cerebellar diaschisis in cerebral infarction: technetium-99 m-HMPAO SPECT and MRI. J Nucl Med. 1997;38:14–9.PubMed
27.
go back to reference Kang KM, Sohn CH, Choi SH, Jung KH, Yoo RE, Yun TJ, et al. Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging. PLoS One. 2017;12:e0173971.CrossRef Kang KM, Sohn CH, Choi SH, Jung KH, Yoo RE, Yun TJ, et al. Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging. PLoS One. 2017;12:e0173971.CrossRef
28.
go back to reference Kamalian S, Kamalian S, Konstas AA, Maas MB, Payabvash S, Pomerantz SR, et al. CT perfusion mean transit time maps optimally distinguish benign oligemia from true “at-risk” ischemic penumbra, but thresholds vary by postprocessing technique. Am J Neuroradiol. 2012;33:545–9.CrossRef Kamalian S, Kamalian S, Konstas AA, Maas MB, Payabvash S, Pomerantz SR, et al. CT perfusion mean transit time maps optimally distinguish benign oligemia from true “at-risk” ischemic penumbra, but thresholds vary by postprocessing technique. Am J Neuroradiol. 2012;33:545–9.CrossRef
29.
go back to reference Biesbroek JM, Niesten JM, Dankbaar JW, Biessels GJ, Velthuis BK, Reitsma JB, et al. Diagnostic accuracy of CT perfusion imaging for detecting acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2013;35:493–501.CrossRef Biesbroek JM, Niesten JM, Dankbaar JW, Biessels GJ, Velthuis BK, Reitsma JB, et al. Diagnostic accuracy of CT perfusion imaging for detecting acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2013;35:493–501.CrossRef
30.
go back to reference Shen J, Li X, Li Y, Wu B. Comparative accuracy of CT perfusion in diagnosing acute ischemic stroke: a systematic review of 27 trials. PLoS One. 2017;12:e0176622.CrossRef Shen J, Li X, Li Y, Wu B. Comparative accuracy of CT perfusion in diagnosing acute ischemic stroke: a systematic review of 27 trials. PLoS One. 2017;12:e0176622.CrossRef
31.
go back to reference Sakai K, Yamada K. Machine learning studies on major brain diseases: 5-year trends of 2014–2018. Jpn J Radiol. 2019;37:34–72.CrossRef Sakai K, Yamada K. Machine learning studies on major brain diseases: 5-year trends of 2014–2018. Jpn J Radiol. 2019;37:34–72.CrossRef
Metadata
Title
Characteristics of cerebral perfusion and diffusion associated with crossed cerebellar diaschisis after acute ischemic stroke
Authors
Miao Zhang
Yanxiang Cao
Fang Wu
Cheng Zhao
Qingfeng Ma
Kuncheng Li
Jie Lu
Publication date
01-02-2020
Publisher
Springer Japan
Published in
Japanese Journal of Radiology / Issue 2/2020
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-019-00898-0

Other articles of this Issue 2/2020

Japanese Journal of Radiology 2/2020 Go to the issue