Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Child's Nervous System
Published in: Child's Nervous System 6/2011

01-06-2011 | Original Paper

Long-term sequelae after acquired pediatric hemorrhagic cerebellar lesions

Authors: Kevin Wingeier, Sandra Bigi, Marwan El-Koussy, Theda Heinks-Maldonado, Eugen Boltshauser, Maja Steinlin

Published in: Child's Nervous System | Issue 6/2011

Login to get access

Abstract

Purpose

The aim of the present study was to assess cognitive, affective, and motor long-term sequelae after acquired focal pediatric cerebellar lesions.

Methods

Eight patients with a history of isolated acquired hemorrhagic cerebellar lesions before the age of 13 participated in this study. All participants underwent a neurologic examination, including the Zurich Neuromotor Assessment (ZNA) and the International Cooperative Ataxia Rating Scale (ICARS). Cognitive functions have been evaluated with a general cognitive assessment and an extensive neuropsychological battery. Furthermore, patients and parents filled in questionnaires about quality of life and possible behavioral or emotional problems.

Results

The results revealed that all patients exhibited motor problems (ZNA). Most participants had further restricted oculomotor movements (ICARS). Age at injury and the full scale IQ were significantly positively correlated (Pearson correlation 0.779; p = 0.023). Conversely, no overall neuropsychological profile could be identified except for marginally reduced reaction times and susceptibility to interference. In addition, borderline results in semantic and phonemic word fluency tasks were apparent. A dysexecutive syndrome was diagnosed in one patient. However, verbal performance and reading abilities were non-pathologic in all participants. The patients reported having a good quality of life without major physical restrictions.

Conclusions

Emotional disturbances and the presence of a mild cerebellar cognitive affective syndrome (as frequently described in adult patients) could only be confirmed in adolescents with vermis lesions. Nevertheless, in laboratory conditions, neuropsychological impairments were present in all patients. Heterogeneity of age at injury and exact lesion site may have led to interpersonal differences in neuropsychological outcome.
Literature
1.
2.
Leiner HC, Leiner AL, Dow RS (1986) Does the cerebellum contribute to mental skills? Behav Neurosci 100:443–454PubMedCrossRef
3.
Bracke-Tolkmitt R, Linden A, Canavan AGM, Rockstroh B, Scholz E, Wessel K et al (1989) The cerebellum contributes to mental skills. Behav Neurosci 103(2):442–446CrossRef
4.
Mariën P, Baillieux H, De Smet HJ et al (2009) Cognitive, linguistic and affective disturbances following a right superior cerebellar artery infarction: a case study. Cortex 45:527–536PubMedCrossRef
5.
Ackermann H, Mathiak K, Riecker A (2007) The contribution of the cerebellum to speech production and speech perception: clinical and functional imaging data. Cerebellum 6:202–213PubMedCrossRef
6.
Ben-Yehudah G, Fiez JA (2008) Impact of cerebellar lesions on reading and phonological processing. Ann NY Acad Sci 1145:260–1174PubMedCrossRef
7.
Murdoch BE (2009) The cerebellum and language: historical perspective and review. Cortex 46(7):858–868PubMedCrossRef
8.
Kalashnikova LA, Zueva YV, Pugacheva OV, Korsakova NK (2005) Cognitive impairments in cerebellar infarcts. Neurosci Behav Physiol 35(8):773–779PubMedCrossRef
9.
Molinari M, Leggio MG (2007) Cerebellar information processing and visuospatial functions. Cerebellum 6:214–220PubMedCrossRef
10.
Hoffmann M, Schmitt F (2004) Cognitive impairment in isolated subtentorial stroke. Acta Neurol Scand 109:14–24PubMedCrossRef
11.
Ravizza SM, McCormick CA, Schlerf JE, Justus T, Ivry RB, Fiez JA (2006) Cerebellar damage produces selective deficits in verbal working memory. Brain 129:306–320PubMedCrossRef
12.
Whigham KB, O’Toole K (2007) Understanding the neuropsychologic outcome of pediatric AVM within a neurodevelopmental framework. Cognit Behav Neurol 20:244–257CrossRef
13.
Ben-Yehudah G, Guediche S, Fiez JA (2007) Cerebellar contributions to verbal working memory: beyond cognitive theory. Cerebellum 6:193–201PubMedCrossRef
14.
Leggio MG, Tedesco AM, Chiricozzi FR, Clausi S, Orsini A, Molinari M (2008) Cognitive sequencing impairment in patients with focal or atrophic cerebellar damage. Brain 131:1332–1343PubMedCrossRef
15.
Molinari M, Chiricozzi FR, Clausi A, Tedesco AM, De Lisa M, Leggio MG (2008) Cerebellum and detection of sequences, from perception to cognition. Cerebellum 8:611–615CrossRef
16.
17.
Timmann D, Konczak J, Ilg W, Domchin O, Hermsdörfer J, Gizewski ER, Schoch B (2009) Current advances in lesion-symptom mapping of the human cerebellum. Neuroscience 162(3):836–851PubMedCrossRef
18.
Kim SG, Ugurbil K, Strick P (1994) Activation of a cerebellar output nucleus during cognitive processing. Science 265:949–951PubMedCrossRef
19.
Hu D, Shen H, Zhou Z (2008) Functional asymmetry in the cerebellum. A brief review. Cerebellum 7(3):304–313PubMedCrossRef
20.
21.
Middleton FA, Strick PL (1994) Anatomical evidence for cerebellar and basal ganglia involvement in higher cognitive function. Science 266:485–461CrossRef
22.
23.
Gasparini M, DiPiero C, Ciccarelli O, Cacioppo MM, Pantano P, Lenzi GL (1999) Linguistic impairment after right cerebellar stroke: a case report. Eur J Neurol 6:353–356PubMedCrossRef
24.
Scott RB, Stoodley CJ, Anslow P, Stein J, Sugden EM, Mitchell CD (2001) Lateralized cognitive deficits in children following cerebellar lesions. Dev Med Child Neurol 43:685–691PubMedCrossRef
25.
Riva D (2000) Cerebellar contribution to behaviour and cognition in children. J Neurolinguist 13:215–225CrossRef
26.
Schmahmann JD, Caplan D (2006) Cognition, emotion and the cerebellum. Brain 129:288–292
27.
28.
Baillieux H, De Smet HJ, Lesage G, Paquier P, Deyn D, Mariën P (2006) Neurobehavioral alternations in an adolescent following posterior fossa tumor resection. Cerebellum 5:289–295PubMedCrossRef
29.
Levinsohn L, Cronin-Golomb A, Schmahmann JD (2000) Neuropsychological consequences of cerebellar tumor resection in children: cerebellar cognitive affective syndrome in a paediatric population. Brain 123:1041–1050CrossRef
30.
Charalambides C, Dinopoulos A, Sgouros S (2009) Neuropsychological sequelae and quality of life following treatment of posterior fossa ependymomas in children. Childs Nerv Syst 25(10):1313–1320PubMedCrossRef
31.
Kossorotoff M, Gonin-Flambois C, Gitiaux C, Quijano S, Boddaert N, Bahi-Buisson N et al (2010) A cognitive and affective pattern in posterior fossa strokes in children: a case series. Dev Med Child Neurol 52(7):626–831PubMedCrossRef
32.
Riva D, Giorgi C (2000) The cerebellum contributes to higher functions during development: evidence from a series of children surgically treated for posterior fossa tumours. Brain 123:1051–1061PubMedCrossRef
33.
Shevell MI, Majnemer A (1996) Clinical features of developmental disability associated with cerebellar hypoplasia. Pediatr Neurol 15:224–229PubMedCrossRef
34.
Steinlin M (2007) The cerebellum in cognitive processes: supporting studies in children. Cerebellum 6:237–241PubMedCrossRef
35.
Steinlin M, Schmid M, Landau K, Boltshauser E (1997) Follow-up in children with Joubert syndrome. Neuropediatrics 28(4):204–211PubMedCrossRef
36.
Volpe JJ (2009) Cerebellum of the premature infant: rapidly developing, vulnerable, clinically important. J Child Neurol 24(9):1085–1104PubMedCrossRef
37.
Messerschmidt A, Fuiko R, Prayer D, Brugger PC, Boltshauser E, Zoder G, Sterniste W, Weber M, Birnbacher R (2008) Disrupted cerebellar development in preterm infants is associated with impaired neurodevelopmental outcome. Eur J Pediatr 167(10):1141–1147PubMedCrossRef
38.
Tavano A, Grasso R, Gagliardi C, Triulzi F, Bresolin N, Fabbro F, Borgatti R (2007) Disorders of cognitive and affective development in cerebellar malformations. Brain 130:2646–2660PubMedCrossRef
39.
Steinlin M, Imfeld S, Zulauf P, Boltshauser E, Lövblad KO, Ridolfi Lüthy A, Perrig W, Kaufmann F (2003) Neuropsychological long-term sequelae after posterior fossa tumour resection during childhood. Brain 126:1988–2008CrossRef
40.
Steinlin M, Pfister I, Pavlovic J, Everts R, Boltshauser E, Capone Mori A et al (2005) The first three years of the Swiss Neuropaediatric Stroke Registry (SNPSR): a population-based study of incidence, symptoms and risk factors. Neuropediatrics 36(2):90–97PubMedCrossRef
41.
Trouillas P, Takayanagi T, Hallett M, Currier RD, Subramony SH, Wessel K et al (1997) International Cooperative Ataxia Rating scale for pharmacological assessment of the cerebellar syndrome. The Ataxia Neuropharmacology Committee of the World Federation of Neurology. J Neurol Sci 145:205–211PubMedCrossRef
42.
Schoch B, Regel JR, Frings M et al (2007) Reliability and validity of ICARS in focal cerebellar lesions. Mov Disord 22(15):2162–2169PubMedCrossRef
43.
44.
45.
Rapoport M, van Reekum R, Mayberg H (2000) The role of the cerebellum in cognition and behavior: a selective review. J Neuropsychiatr Clin Neurosci 12:193–198CrossRef
5-point Test: Regard M, Stauss E, Knapp P (1982) Children`s production of verbal and nonverbal fluency tasks. Perceptual and Motor Skills 55: 839–844
Child Behaviour Check List (CBCL) and Youth Self Report (YSR): Achenbach TM (1991) Manual for the Child Behavior Checklist/4–18 and the 1991 Profile. Burlington, USA: University of Vermont, Department of Psychiatry
Corsi Block Tapping Test (CORSI): Milner B (1971) Interhemispheric differences in the localization of psychological processes in man. British Medical Bulletin 27, 273–277
Delis-Kaplan Executive Function System (D-KEFS): Delis DC, Kaplan E, Framer IH (2001) Delis–Kaplan Executive Function System. San Antonio, USA: Psychological Corporation. Harcourt Brace and Company
International Cooperative Ataxia Rating Scale (ICARS): Trouillas P, Takayanagi T, Hallett M, et al. (1997) International Cooperative Ataxia Rating scale for pharmacological assessment of the cerebellar syndrome. The Ataxia Neuropharmacology Committee of the World Federation of Neurology. Journal of Neurological Sciences 145: 205–211
Kidscreen-52 questionnaire: Ravens-Sieberer U, Gosch A, Abel T, Auquier P, Bellach BM, Bruil J, and the European Kidscreen Group (2001) Quality of life in children and adolescents: a European public health perspective. Social and Preventive Medicine 46: 297–302
Marburger inventory to establish the quality of life in children and adolescents (ILK-MARSYS): Mattejat F, Remschmidt H (2006) Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen. Ratingbogen für Kinder, Jugendliche und Eltern. Bern, Switzerland: Verlag Hans Huber. (in German)
Regensburger Word Fluency Test (RWT): Aschenbrenner S, Tucha O, Lange KW (2000) Regensburger Word Fluency Test (German version). Göttingen, Germany: Hogrefe. (in German)
Rey Auditory Verbal Learning Test (RAVLT): Rey A (1964) L`examen clinique en psychologie. Paris: Presses Universitaire de France. (in French)
Rey Osterrieth Complex Figure (REY figure): Rey A (1941) L`examen psychologique dans les cas d`encephalopathie traumatique. Archives de Psychologie 28,286-340. (in French)
Waber D, Holmes JM (1985) Assessing children’s copy productions of the Rey Osterrieth Complex Figure. Journal of Clinical and Experimental Neuropsychology 7: 264–280
Rey Visual Design Learning Test (RVDLT): Rey A (1964) L`examen clinique en psychologie. Paris: Presses Universitaire de France. (in French)
Test battery of attentional performance (TAP): Zimmermann P, Fimm B (2002) TAP Testbatterie zur Aufmerksamkeitsprüfung. Herzogenrath, Germany: Psytest. (in German)
Wechsler Intelligence Scale for Adults, 3rd edition (WAIS-III): Wechsler D (1999) Wechsler Abbreviated Scales of Intelligence (German version). San Antonio, USA: Psychological Corporation. Harcourt Brace and Company
Wechsler Intelligence Scale for Children, 4th edition (WISC-IV): Wechsler D (1991) Wechsler Intelligence Scales for children (German version). San Antonio, USA: Psychological Corporation. Harcourt Brace and Company
Wisconsin Card Sorting Test (WSCT): Psychological Assessment Resources (2003) Computerized Wisconsin Card Sort Task Version 4 (WCST). Lutz, USA: Psychological Assessment Resources
Zurich Neuromotor Assessment battery (ZNA): Largo RH, Fischer J, Caflisch J (2002) Zurich Neuromotor Assessement. Zurich, Switzerland: AWE Verlag. (in German)
Metadata
Title
Long-term sequelae after acquired pediatric hemorrhagic cerebellar lesions
Authors
Kevin Wingeier
Sandra Bigi
Marwan El-Koussy
Theda Heinks-Maldonado
Eugen Boltshauser
Maja Steinlin
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 6/2011
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-010-1357-x

Other articles of this Issue 6/2011

Child's Nervous System 6/2011 Go to the issue

Book Review

B.A. Akbarnia, M. Yazici, G. Thompson (eds): The growing spine

Letter to the Editor

MRI follow up of intracranial endodermal cysts

Original Paper

Incidence of vasculopathy in children with hypothalamic/chiasmatic gliomas treated with brachytherapy

Review Paper

Postoperative cerebellar mutism and autistic spectrum disorder

Brief Communication

The histone deacetylase inhibitor sodium butyrate in combination with brain-derived neurotrophic factor reduces the viability of DAOY human medulloblastoma cells

Letter to the Editor

Letter to the editor