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Crossed Cerebellar Diaschisis
KEY FACTS
Terminology
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Diaschisis = sudden loss of function in brain connected to (but at distance from) damaged area
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Crossed cerebellar diaschisis (CCD) = decreased blood flow/metabolism in cerebellar hemisphere contralateral to supratentorial infarct
Imaging
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Acute: CT/MR perfusion shows ↓ cerebral blood flow (CBF) in cerebellar hemisphere opposite acute hemispheric infarct
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↑ Time to peak, ↓ CBF in cerebellum contralateral to infarct
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Add DTI as subtle cases may show ↓ fractional anisotropy when conventional MR normal
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FDG-18 PET/CT shows diffusely reduced uptake in contralateral cerebellar hemisphere
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Chronic: CT or MR shows atrophic cerebellar hemisphere opposite old cerebral hemispheric infarct
Top Differential Diagnoses
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Superior cerebral artery infarct
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CCD involves > just superior cerebral artery territory
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Encephalomalacia
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Trauma, infection, surgery
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Cerebellitis
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Cerebellum swollen, hyperintense (not shrunken, atrophic)
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Pathology
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Corticopontocerebellar (CPC) tract
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Input to cerebellum via CPC tracts 40x all other afferent sources combined
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Injury at any point along CPC can result in ↓ CBF, metabolism in contralateral cerebellar hemisphere
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Most common cause = middle cerebral artery infarct
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Others = status epilepticus, neoplasm, trauma, surgery, migraine, Rasmussen encephalitis, etc.
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Axial T2WI MR in a patient with a remote left middle cerebral artery infarct shows the typical changes of encephalomalacia and volume loss
. The ipsilateral ventricle is enlarged
.
. The ipsilateral ventricle is enlarged .
Axial T2 MR in the same patient shows volume loss with enlarged horizontal sulci in the contralateral cerebellar hemisphere
. These findings are consistent with chronic crossed cerebellar diaschisis (CCD).
. These findings are consistent with chronic crossed cerebellar diaschisis (CCD).
MR perfusion study cerebral blood flow (CBF) map in a patient with acute right hemiparesis shows diminished blood flow
(blue area) in the left middle cerebral artery distribution.
(blue area) in the left middle cerebral artery distribution.
CBF map in the same patient demonstrates reduced CBF in the right cerebellar hemisphere
consistent with acute CCD. CCD is caused by an interruption of the corticopontocerebellar fibers. As a result of ↓ afferent input, there is a ↓ in cerebellar metabolism, coupled with a ↓ in cerebellar perfusion.
consistent with acute CCD. CCD is caused by an interruption of the corticopontocerebellar fibers. As a result of ↓ afferent input, there is a ↓ in cerebellar metabolism, coupled with a ↓ in cerebellar perfusion.
TERMINOLOGY
Abbreviations
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Crossed cerebellar diaschisis (CCD)
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