RESUMEN
BACKGROUND: In the recent literature there is no consensus regarding the relationships between crossed cerebellar diaschisis (CCD) with the primary lesion size, severity or location. Thus, the aim of the present study was to investigate relationship between the size and severity of cerebral lesions and CCD in patients with chronic stroke, using voxel-based analysis of Tc-99m ECD single-photon emission computed tomography (SPECT). MATERIAL AND METHODS: We retrospectively reviewed data of 57 patients with chronic ischemic lesions localized unilaterally in the cerebral hemisphere. SPECT evaluation was performed with the voxel-based analysis. The percentage inter-hemispheric asymmetry index (AI) and the volume of abnormal clusters of voxels (CV) were ascertained for hypoperfusion in the supratentorial lesion and contralateral cerebellum. RESULTS: CCD was present in 35.1% cases. In Group CCD (+), the CV and AI of supratentorial hypoperfusion (median 128.1 ml and 21.9%, respectively) were significantly higher compared with Group CCD(-) (median 41.4 ml and 18.0%, respectively). Statistically significant correlation was found between CV of supratentorial and cerebellar perfusion defects (r = 0.4; p < 0.05), between AI of supratentorial and cerebellar perfusion defects (r = 0.6; p < 0.05) and between CV of supratentorial defect and AI of cerebellar perfusion defects (r = 0.6; p < 0.05). CONCLUSIONS: Our data suggest, that in the chronic stage of stroke, the size and severity of the supratentorial lesion are determinants of CCD, correlating with the degree of cerebellar hypoperfusion.
Asunto(s)
Encéfalo/diagnóstico por imagen , Enfermedades Cerebelosas/diagnóstico por imagen , Cisteína/análogos & derivados , Procesamiento de Imagen Asistido por Computador , Compuestos de Organotecnecio , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Deep brain stimulation (DBS) of the sensory thalamus and the periventricular/ peri-aqueductal grey area complex may be applied for the treatment of intractable neuropathic pain syndrome. The presented study concerns a patient who experienced ischemic stroke within the posterolateral part of the left hypothalamus, with subsequent severe burning pain localized in the right upper limb, predominantly within the hand, and thalamic tremor which occurred 4 months after the stroke. After 2 years of ineffective pain treatment, the patient was offered implantation of electrodes to the periventricular grey matter (PVG)/periaqueductal grey matter (PAG), as well as implantation of an electrode to the ventroposterolateral thalamic nucleus (VPL). Soon after starting simultaneous PAG/PVG and PVL stimulation, significant alleviation of the patient's thalamic tremor in the hand was observed, which persisted over subsequent months. The presented study discusses possible mechanism underlying tremor suppression in the patient concerned, probably at the level of the cerebellar outflow pathways. The study highlights the fact that DBS provide more insight into the functional anatomy of the thalamus, which used to be available only from animal studies.