Crossed Cerebellar Diaschisis Worsens the Clinical Presentation in Acute Large Vessel Occlusion

Clinical Research in Stroke

Abderrakib A.a· Ligot N.a· Torcida N.a· Sadeghi Meibodi N.b· Naeije G.a

Author affiliations

aNeurology Department, Université Libre de Bruxelles – Cliniques Universitaires de Bruxelles – Hôpital Erasme, Bruxelles, Belgium
bRadiology Department, Université Libre de Bruxelles – Cliniques Universitaires de Bruxelles – Hôpital Erasme, Bruxelles, Belgium

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply

Start free trial

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Abstract of Clinical Research in Stroke

Received: October 15, 2022
Accepted: December 02, 2022
Published online: January 30, 2023

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Introduction: Initial NIHSS in anterior large vessel occlusion (LVO) correlates partially with the hypoperfusion volume. We aimed at assessing the contribution of crossed cerebellar diaschisis (CCD) from the hypoperfused territory on LVO initial clinical deficit. Methods: CCD was retrospectively identified by brain CT perfusion imaging (CTP) in patients with anterior LVO treated by mechanical thrombectomy from January 2017 to July 2021. CCD was defined by CTP parameter alteration in the contralateral cerebellar hemisphere to the LVO. NIHSS, clinical/perfusion variables, and CCD were included in regression models to assess their interrelationships. Results: 206 patients were included. CCD was present in 90 patients (69%). NIHSS scores were higher on admission and at stroke discharge among patients with CCD (17.90 ± 6.1 vs. 11.4 ± 8.4, p < 0.001; 9.6 ± 7.7 vs. 6.6 ± 7.9, p = 0.049; respectively). Patients with a CCD had higher stroke volumes (118.2 ± 60.3 vs. 69.3 ± 59.7, p < 0.001) and lower rate of known atrial fibrillation (22% vs. 41%, p = 0.021). On multivariable logistic regression, CCD independently worsened the initial NIHSS (OR 4.85 [2.37–7.33]; p < 0.001). Conclusion: CCD is found in 69% of LVO on admission CTP, correlates with stroke volumes, and independently worsens initial NIHSS.

© 2023 S. Karger AG, Basel

References National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7. Lyden P. Using the National Institutes of Health Stroke Scale: a cautionary tale. Stroke. 2017;48(2):513–9. Fink JN, Selim MH, Kumar S, Silver B, Linfante I, Caplan LR, et al. Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for patients with right- and left-hemisphere ischemic stroke? Stroke. 2002;33(4):954–8. Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME. Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology. 1998;50(4):864–70. Woo D, Broderick JP, Kothari RU, Lu M, Brott T, Lyden PD, et al. Does the National Institutes of Health Stroke scale favor left hemisphere strokes? NINDS t-PA stroke study group. Stroke. 1999;30(11):2355–9. Saposnik G, Guzik AK, Reeves M, Ovbiagele B, Johnston SC. Stroke prognostication using age and NIH stroke scale: SPAN-100. Neurology. 2013;80(1):21–8. Ospel JM, Brown S, Kappelhof M, van Zwam W, Jovin T, Roy D, et al. Comparing the prognostic impact of age and baseline National Institutes of Health Stroke scale in acute stroke due to large vessel occlusion. Stroke. 2021;52(9):2839–45. Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31. Finger S, Koehler PJ, Jagella C. The monakow concept of diaschisis origins and perspectives. Arch Neurol. 2004;61(2):283–8. Carrera E, Tononi G. Diaschisis: past, present, future. Brain. 2014;137(Pt 9):2408–22. Dobkin JA, Levine RL, Lagreze HL, Dulli DA, Nickles RJ, Rowe BR. Evidence for transhemispheric diaschisis in unilateral stroke. Arch Neurol. 1989;46(12):1333–6. Lagrèze HL, Levine RL, Pedula KL, Nickles RJ, Sunderland JS, Rowe BR. Contralateral flow reduction in unilateral stroke: evidence for transhemispheric diaschisis. Stroke. 1987;18(5):882–6. Baron JC, D’antona R, Pantano P, Serdaru M, Samson Y, Bousser MG. Effects of thalamic stroke on energy metabolism of the cerebral cortex. A positron tomography study in man. Brain. 1986;109(Pt 6):1243–59. Pappata S, Mazoyer B, Tran Dinh S, Cambon H, Levasseur M, Baron JC. Effects of capsular or thalamic stroke on metabolism in the cortex and cerebellum: a positron tomography study. Stroke. 1990;21(4):519–24. Chu WJ, Mason GF, Pan JW, Hetherington HP, Liu HG, San Pedro EC, et al. Regional cerebral blood flow and magnetic resonance spectroscopic imaging findings in diaschisis from stroke. Stroke. 2002;33(5):1243–8. 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(4):743–54. Pantano P, Baron JC, Samson Y, Bousser MG, Derouesne C, Comar D. Crossed cerebellar diaschisis: further studies. Brain. 1986;109:677–94. Sobesky J, Thiel A, Ghaemi M, Hilker RH, Rudolf J, Jacobs AH, et al. Crossed cerebellar diaschisis in acute human stroke: a PET study of serial changes and response to supratentorial reperfusion. J Cereb Blood Flow Metab. 2005;25(12):1685–91. Baumann O, Borra RJ, Bower JM, Cullen KE, Habas C, Ivry RB, et al. Consensus paper: the role of the cerebellum in perceptual processes. Cerebellum. 2015;14(2):197–220. Kelly RM, Strick PL. Cerebellar loops with motor cortex and prefrontal cortex of a nonhuman primate. J Neurosci. 2003;23:8432–44. Ramnani N. The primate cortico-cerebellar system: anatomy and function. Nat Rev Neurosci. 2006;7:511–22. Infeld B, Davis SM, Lichtenstein M, Mitchell PJ, Hopper JL. Crossed cerebellar diaschisis and brain recovery after stroke. Stroke. 1995;26(1):90–5. Naeije G, Rai M, Allaerts N, Sjogard M, De Tiege X, Pandolfo M. Cerebellar cognitive disorder parallels cerebellar motor symptoms in Friedreich ataxia. Ann Clin Transl Neurol. 2020;7(6):1050–4. Benussi A, Cantoni V, Manes M, Libri I, Dell’Era V, Datta A, et al. Motor and cognitive outcomes of cerebello-spinal stimulation in neurodegenerative ataxia. Brain. 2021;144(8):2310–21. Lin DDM, 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. AJNR Am J Neuroradiol. 2009;30(4):710–5. 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(11):3615–24. Jodaitis L, Ligot N, Chapusette R, Bonnet T, Gaspard N, Naeije G. The hyperdense middle cerebral artery sign in drip-and-ship models of acute stroke management. Cerebrovasc Dis Extra. 2020;10(1):36–43. Ligot N, Elands S, Damien C, Jodaitis L, Sadeghi Meibodi N, Mine B, et al. Stroke core volume weighs more than recanalization time for predicting outcome in large vessel occlusion recanalized within 6 h of symptoms onset. Front Neurol. 2022;13:838192. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18. Elands S, Casimir P, Bonnet T, Mine B, Lubicz B, Sjogard M, et al. Early venous filling following thrombectomy: association with hemorrhagic transformation and functional outcome. Front Neurol. 2021;12:649079. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):e109–37. Knoflach M, Matosevic B, Rücker M, Furtner M, Mair A, Wille G, et al. Functional recovery after ischemic stroke: a matter of age – data from the Austrian Stroke Unit Registry. Neurology. 2012;78(4):279–85. Almekhlafi MA, Davalos A, Bonafe A, Chapot R, Gralla J, Pereira VM, et al. Impact of age and baseline NIHSS scores on clinical outcomes in the mechanical thrombectomy using solitaire FR in acute ischemic stroke study. AJNR Am J Neuroradiol. 2014;35(7):1337–40. Campbell BCV, Majoie CBLM, Albers GW, Menon BK, Yassi N, Sharma G, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol. 2019;18(1):46–55. Olivot J-M, Albucher J-F, Guenego A, Thalamas C, Mlynash M, Rousseau V, et al. Mismatch profile influences outcome after mechanical thrombectomy. Stroke. 2021;52(1):232–40. Henninger N, Goddeau RP, Karmarkar A, Helenius J, McManus DD. Atrial fibrillation is associated with a worse 90-day outcome than other cardioembolic stroke subtypes. Stroke. 2016;47(6):1486–92. Sporns PB, Hanning U, Schwindt W, Velasco A, Minnerup J, Zoubi T, et al. Ischemic stroke: what does the histological composition tell us about the origin of the thrombus? Stroke. 2017;48(8):2206–10. Meneghetti G, Vorstrup S, Mickey B, Lindewald H, Lassen NA. Crossed cerebellar diaschisis in ischemic stroke: a study of regional cerebral blood flow by 133Xe inhalation and single photon emission computerized tomography. J Cereb Blood Flow Metab. 1984;4(2):235–40. Sebök M, van Niftrik CHB, Piccirelli M, Muscas G, Pangalu A, Wegener S, et al. Crossed cerebellar diaschisis in patients with symptomatic unilateral anterior circulation stroke is associated with hemodynamic impairment in the ipsilateral MCA territory. J Magn Reson Imaging. 2021;53(4):1190–7. von Bieberstein L, van Niftrik CHB, Sebök M, El Amki M, Piccirelli M, Stippich C, et al. Crossed cerebellar diaschisis indicates hemodynamic compromise in ischemic stroke patients. Transl Stroke Res. 2021;12(1):39–48. Kamouchi M, Fujishima M, Saku Y, Ibayashi S, Iida M. Crossed cerebellar hypoperfusion in hyperacute ischemic stroke. J Neurol Sci. 2004;225(1–2):65–9. Guglielmi V, LeCouffe NE, Zinkstok SM, Compagne KCJ, Eker R, Treurniet KM, et al. Collateral circulation and outcome in atherosclerotic versus cardioembolic cerebral large vessel occlusion. Stroke. 2019;50(12):3360–8. Rebello LC, Bouslama M, Haussen DC, Grossberg JA, Dehkharghani S, Anderson A, et al. Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes. Eur J Neurol. 2017;24(6):762–7. Gold L, Lauritzen M. Neuronal deactivation explains decreased cerebellar blood flow in response to focal cerebral ischemia or suppressed neocortical function. Proc Natl Acad Sci U S A. 2002;99(11):7699–704. Dettmers C, Hartmann A, Rommel T, Hartmann S, Pappata S, Baron JC. Contralateral cerebellar diaschisis 7 hours after MCA-occlusion in primates. Neurol Res. 1995;17(2):109–12. Pantano P, Lenzi GL, Guidetti B, Di Piero V, Gerundini P, Savi AR, et al. Crossed cerebellar diaschisis in patients with cerebral ischemia assessed by SPECT and 123I-HIPDM. Eur Neurol. 1987;27(3):142–8. Miura H, Nagata K, Hirata Y, Satoh Y, Watahiki Y, Hatazawa J. Evolution of crossed cerebellar diaschisis in middle cerebral artery infarction. J Neuroimaging. 1994;4(2):91–6. Kim Y, Lim SH, Park GY. Crossed cerebellar diaschisis has an adverse effect on functional outcome in the subacute rehabilitation phase of stroke: a case-control study. Arch Phys Med Rehabil. 2019;100(7):1308–16. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med. 2018;378(17):1573–82. Abderrakib A, Torcida N, Sadeghi N, Naeije G. Crossed cerebellar diaschisis worsens the clinical presentation in acute large vessel occlusion. 2022. Article / Publication Details

First-Page Preview

Abstract of Clinical Research in Stroke

Received: October 15, 2022
Accepted: December 02, 2022
Published online: January 30, 2023

Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

留言 (0)

沒有登入
gif