Ann Rehabil Med.  2018 Feb;42(1):8-17. 10.5535/arm.2018.42.1.8.

Crossed Cerebellar Diaschisis: Risk Factors and Correlation to Functional Recovery in Intracerebral Hemorrhage

• Sin DS
• Kim MH
• Park SA
• Joo MC
• Kim MS

• KMID: 2440964
• DOI: http://doi.org/10.5535/arm.2018.42.1.8

Abstract

OBJECTIVE
The purpose of this study is to investigate predictors of crossed cerebellar diaschisis (CCD), and the effects of CCD on functional outcomes including motor function, activities of daily living, cognitive function, and ambulation 6 months after onset in patients with intracerebral hemorrhage (ICH).
METHODS
A total of 74 patients experiencing their first ICH were recruited. If the asymmetric index was more than 10% using single photon emission computed tomography (SPECT), a diagnosis of CCD was confirmed. Clinical factors were retrospectively assessed by reviewing medical records. Radiologic factors encompassed the concomitance of intraventricular hemorrhage, side and location of the lesion, and hemorrhage volume. Functional outcomes were evaluated using the Fugl-Meyer Assessment, the Korean version of the Mini-Mental State Examination, the Korean version of the Modified Barthel Index, and measurement of the Functional Ambulatory Category at the time of SPECT measurement and 6 months post-ICH.
RESULTS
Lesion location, especially in the basal ganglia (odds ratio [OR]=6.138, p=0.011), and hemorrhagic volume (OR=1.055, p=0.046) were independent predictors for CCD according to multivariate logistic regression analysis. In addition, the presence of CCD was significantly related to the improvement in Fugl-Meyer Assessment score after 6 months (adjusted R2=0.152, p=0.036).
CONCLUSION
Lesion location and hemorrhagic volume were the predisposing factors for CCD, and the CCD was associated with poor motor recovery over 6 months in patients with hemorrhagic stroke.

Keyword

Cerebellum; Cerebral hemorrhage; Recovery of function; Risk factors; Single-photon emission-computed tomography

MeSH Terms

Activities of Daily Living
Basal Ganglia
Causality
Cerebellum
Cerebral Hemorrhage*
Cognition
Diagnosis
Hemorrhage
Humans
Logistic Models
Medical Records
Recovery of Function
Retrospective Studies
Risk Factors*
Stroke
Tomography, Emission-Computed, Single-Photon
Walking

Figure

• 

  Fig. 1 Flow chart for the patient selection process. We reviewed the medical records of patients who visited Wonkwang University Hospital from January 2011 to December 2015 diagnosed with their first intracerebral hemorrhage (ICH) in the basal ganglia, thalamus, or lobes. Among them, patients who had concomitant cerebral infarction were excluded. After that, patients who met the exclusion criteria were excluded. Finally, patients who had poor single-photon emission-computed tomography (SPECT) images were excluded.

• 

  Fig. 2 Brain single-photon emission-computed tomography (SPECT) image of a 69-year-old woman. She had a right basal ganglia hemorrhage on the CT. (A) Baseline SPECT showed a severe perfusion deficit in the right basal ganglia and surrounding area. (B) Moderate hypoperfusion in the left lateral zone of the cerebellum (white arrowhead) was also noticed. In this case, asymmetry index was 24.7% and she was diagnosed to have crossed cerebellar diaschisis.

• 

  Fig. 3 Determination of the presence of crossed cerebellar diaschisis (CCD). Regions of interest (ROI) were drawn in the lateral zone of the cerebellum. The mean counts per pixel of ROIs were quantitatively measured in sequential 3 axial images showing prominent cerebellar perfusion asymmetry and mean value was calculated. The cerebellar interhemispheric asymmetry index (AI) was measured. Finally, CCD has confirmed if AI was more than 10%.

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