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A subtle connection between crossed cerebellar diaschisis and supratentorial collateral circulation in subacute and chronic ischemic stroke

      Highlights

      • Subtle relationship between CCD and patient prognosis.
      • Poor collateral circulation represents microcirculation disorders.
      • The collateral grade can affect the occurrence of CCD.
      • Neurovascular interaction may be involved in the mechanism of CCD.

      Abstract

      Objectives

      It has not been reported whether collateral circulation, a factor closely related to the prognosis of patients with cerebral infarction, is related to the occurrence of crossed cerebellar diaschisis(CCD) or not. Our research attempts to verify the relationship between the collateral circulation grade and the occurrence of CCD, mainly by means of CTA and CTP.

      Materials and methods

      A total of 47 patients were divided into a CCD-positive (Kim et al., 2019) or a CCD-negative group Furlanis et al. (2018) by calculating the asymmetry index (AI) value (<10%) of bilateral cerebellar cerebral blood flow (CBF). A 4-scale grading method was used to evaluate collateral circulation in the supratentorial infarct area, and the four perfusion parameters of the supratentorial and subtentorial brain regions were analyzed and compared between the two groups. The extent of vascular lesions was evaluated by MR sequences including DWI and MRA.

      Results

      Among the four perfusion parameters, except for CBV, were significantly different between the bilateral cerebellum in the CCD-positive group, but only TTP in the supratentorial cerebral infarction area was statistically different in the two groups. Moreover, the collateral circulation sore in the CCD-positive group was significantly lower than that in the CCD-negative group. But no statistical difference was found in the comparison of DWI positive rates between the two groups.

      Conclusion

      The collateral score in the supratentorial infarct area is correlated with the occurrence of CCD,which may be used to explain the effect of CCD on the prognosis of patients.

      Keywords

      Abbreviations:

      CCD (crossed cerebellar diaschisis), CPC (cortico-ponto-cerebellar), AIF (arterial input function), AI (asymmetry index), CTC (cerebello-thalamo-cortical), CCR (cerebral circulation reserves), CG (collateral grade)
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      References

        • Jeon Y.W.
        • Kim S.H.
        • Lee J.Y.
        • et al.
        Dynamic CT perfusion imaging for the detection of crossed cerebellar diaschisis in acute ischemic stroke.
        Korean J Radiol. 2012; 13: 12-19
        • Kunz W.G.
        • Sommer W.H.
        • Hohne C.
        • et al.
        Crossed cerebellar diaschisis in acute ischemic stroke: Impact on morphologic and functional outcome.
        J Cereb Blood Flow Metab. 2017; 37: 3615-3624
        • Patronas N.J.
        • Di Chiro G.
        • Smith B.H.
        • et al.
        Depressed cerebellar glucose metabolism in supratentorial tumors.
        Brain Res. 1984; 291: 93-101
        • Shimada Y.
        • Kojima D.
        • Yoshida J.
        • et al.
        Transient symptomatic downregulation of cortical neurotransmitter receptor function due to cerebral hyperperfusion after arterial bypass surgery for a patient with ischemic moyamoya disease.
        Neurol Med Chir. 2018; 58: 481-484
        • Garg G.
        • Tripathi M.
        • D'Souza M.M.
        • et al.
        Crossed cerebellar diaschisis demonstrated by F-18-FDG-PET/CT.
        Hell J Nucl Med. 2009; 12: 171-172
        • Kim J.S.
        • Kim S.H.
        • Lim S.H.
        • et al.
        Degeneration of the inferior cerebellar peduncle after middle cerebral artery stroke: another perspective on crossed cerebellar diaschisis.
        Stroke. 2019; 50: 2700-2707
        • Engelborghs S.
        • Pickut B.A.
        • Marien P.
        • et al.
        Crossed cerebellar diaschisis and hemiataxia after thalamic hemorrhage.
        J Neurol. 2000; 247: 476-477
        • Liu Y.
        • Karonen J.O.
        • Nuutinen J.
        • et al.
        Crossed cerebellar diaschisis in acute ischemic stroke: a study with serial SPECT and MRI.
        J Cereb Blood Flow Metab. 2007; 27: 1724-1732
        • Sommer W.H.
        • Bollwein C.
        • Thierfelder K.M.
        • et al.
        Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: occurrence and perfusion characteristics.
        J Cerebr Blood Flow Metab Off J Int Soc Cerebr Blood Flow Metab. 2016; 36: 743-754
        • de Havenon A.
        • Haynor D.R.
        • Tirschwell D.L.
        • et al.
        Association of collateral blood vessels detected by arterial spin labeling magnetic resonance imaging with neurological outcome after ischemic stroke.
        JAMA Neurol. 2017; 74: 453-458
        • Bang O.Y.
        • Goyal M.
        • Liebeskind DS.
        Collateral circulation in ischemic stroke: assessment tools and therapeutic strategies.
        Stroke. 2015; 46: 3302-3309
        • Liu S.L.
        • Wang Y.
        • Zhang Y.
        • et al.
        Analysis of CT perfusion imaging in chronic cerebral circulatory insufficiency and its relationship with crossed cerebellar diaschisis.
        Zhonghua Yi Xue Za Zhi. 2017; 97: 359-364
        • Takasawa M.
        • Watanabe M.
        • Yamamoto S.
        • et al.
        Prognostic value of subacute crossed cerebellar diaschisis: single-photon emission CT study in patients with middle cerebral artery territory infarct.
        Am J Neuroradiol. 2002; 23: 189
        • Kang K.M.
        • Sohn C.H.
        • Choi S.H.
        • et al.
        Detection of crossed cerebellar diaschisis in hyperacute ischemic stroke using arterial spin-labeled MR imaging.
        PLoS One. 2017; 12e0173971
        • Hartkamp M.J.
        • van Der Grond J.
        • van Everdingen K.J.
        • et al.
        Circle of Willis collateral flow investigated by magnetic resonance angiography.
        Stroke. 1999; 30: 2671-2678
        • Berkhemer O.A.
        • Jansen I.G.
        • Beumer D.
        • et al.
        Collateral status on baseline computed tomographic angiography and intra-arterial treatment effect in patients with proximal anterior circulation stroke.
        Stroke. 2016; 47: 768-776
        • Parsons MW.
        Perfusion CT: is it clinically useful?.
        Int J Stroke Off J Int Stroke Soc. 2008; 3: 41-50
        • Ma J.
        • Zhao L.
        • Yuan K.
        • et al.
        Crossed cerebellar diaschisis after acute ischemic stroke detected by intravoxel incoherent motion magnetic resonance imaging.
        Neurolog Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2022; 43: 1135-1141
        • Strother M.K.
        • Buckingham C.
        • Faraco C.C.
        • et al.
        Crossed cerebellar diaschisis after stroke identified noninvasively with cerebral blood flow-weighted arterial spin labeling MRI.
        Eur J Radiol. 2016; 85: 136-142
        • Takasawa M.
        • Watanabe M.
        • Yamamoto S.
        • et al.
        Prognostic value of subacute crossed cerebellar diaschisis: single-photon emission CT study in patients with middle cerebral artery territory infarct.
        Am J Neuroradiol. 2002; 23: 189-193
        • Wang J.
        • Pan L.J.
        • Zhou B.
        • et al.
        Crossed cerebellar diaschisis after stroke detected noninvasively by arterial spin-labeling MR imaging.
        BMC Neurosci. 2020; 21: 46
        • Naccarato M.
        • Ajčević M.
        • Furlanis G.
        • et al.
        Novel quantitative approach for crossed cerebellar diaschisis detection in acute ischemic stroke using CT perfusion.
        J Neurol Sci. 2020; 416117008
        • Furlanis G.
        • Ajčević M.
        • Stragapede L.
        • et al.
        Ischemic volume and neurological deficit: correlation of computed tomography perfusion with the national institutes of health stroke scale score in acute ischemic stroke.
        J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2018; 27: 2200-2207
        • Kim Y.
        • Lim S.H.
        • Park G.Y.
        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: 1308-1316
        • Chang C.C.
        • Ku C.H.
        • Chang S.T.
        Postural asymmetry correlated with lateralization of cerebellar perfusion in persons with chronic stroke: a role of crossed cerebellar diaschisis in left side.
        Brain Inj. 2017; 31: 90-97
        • Infeld B.
        • Davis S.M.
        • Lichtenstein M.
        • et al.
        Crossed cerebellar diaschisis and brain recovery after stroke.
        Stroke. 1995; 26: 90-95
        • Chen W.
        • He S.
        • Song H.
        • et al.
        Quantitative ischemic characteristics and prognostic analysis of crossed cerebellar diaschisis in hyperacute ischemic stroke.
        J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2022; 31106344
        • Sommer W.H.
        • Bollwein C.
        • Thierfelder K.M.
        • et al.
        Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: occurrence and perfusion characteristics.
        J Cereb Blood Flow Metab. 2016; 36: 743-754
        • Flores A.
        • Rubiera M.
        • Ribo M.
        • et al.
        Poor collateral circulation assessed by multiphase computed tomographic angiography predicts malignant middle cerebral artery evolution after reperfusion therapies.
        Stroke. 2015; 46: 3149-3153
        • Ginsberg M.D.
        The cerebral collateral circulation: Relevance to pathophysiology and treatment of stroke.
        Neuropharmacology. 2018; 134: 280-292
        • Machado A.
        • Baker K.B.
        Upside down crossed cerebellar diaschisis: proposing chronic stimulation of the dentatothalamocortical pathway for post-stroke motor recovery.
        Front Integr Neurosci. 2012; 6: 20
        • Zhang M.
        • Cao Y.
        • Wu F.
        • et al.
        Characteristics of cerebral perfusion and diffusion associated with crossed cerebellar diaschisis after acute ischemic stroke.
        Jpn J Radiol. 2020; 38: 126-134
        • Doya K.
        Complementary roles of basal ganglia and cerebellum in learning and motor control.
        Curr Opin Neurobiol. 2000; 10: 732-739
        • Avanzino L.
        • Abbruzzese G.
        How does the cerebellum contribute to the pathophysiology of dystonia?.
        Basal Ganglia. 2012; 2: 231-235
        • Krainik A.
        • Hund-Georgiadis M.
        • Zysset S.
        • et al.
        Regional impairment of cerebrovascular reactivity and BOLD signal in adults after stroke.
        Stroke. 2005; 36: 1146-1152
        • Lan L.F.
        • Leng X.Y.
        • Ip V.
        • et al.
        Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: the roles of antegrade residual flow and leptomeningeal collateral flow.
        J Cereb Blood Flow Metab. 2020; 40: 126-134