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Crossed cerebellar diaschisis in status epilepticus
To cite this article: Bailly P, et al. Crossed cerebellar diaschisis in status epilepticus. Presse Med. (2016), http://dx.doi.org/ 10.1016/j.lpm.2016.06.034 Presse Med. 2016; //: ///
Crossed cerebellar diaschisis in status epilepticus Diaschisis cérébelleux croisé au cours d'un état de mal épileptique
cortex of the left hemisphere (Figures 1 and 2), ipsilateral pulvinar and right cerebellum (Figure 3). Magnetic resonance (MR) angiography showed no vessel occlusion. MRI findings were consistent with focal status epilepticus and crossed cerebellar diaschisis (CCD). Sedation was stopped. Consciousness improved. Patient was discharged from ICU at day 14. Right hemiparesis and aphasia persisted at day 30.
Letter to the editor
en ligne sur / on line on www.em-consulte.com/revue/lpm www.sciencedirect.com
Discussion Case report A 43-year-old man with medical history of alcoholism, diabetes mellitus and head trauma was found unresponsive at home. Physical examination showed apyrexia and a convulsive status epilepticus (SE) without focal signs. Capillary blood glucose was normal. Because of no response to standard treatment regimens for SE, he was sedated, intubated and admitted in ICU. Seizures stopped. Comprehensive laboratory investigations (including lumbar puncture) were negative. EEG performed under sedation found no sign of persistence of SE. Patient was treated with levetiracetam. Brain MRI revealed restricted diffusion within the
CCD was first described in the early twentieth century by Monakow [1]. It can be due to supratentorial stroke, tumours and SE. CCD is due to a hyperactivation–deafferentation phenomenon. It may represent injury caused by excessive neuronal transmission from prolonged excitatory synaptic activity via the cortico-pontine-cerebellar or cortico-thalamic-cerebellar pathways [2]. This leads to loss of function and metabolism, neural depression in the contralateral cerebellum (linked to the injured area) and sometimes neurodegeneration. Its reversibility would be related to the severity of the supratentorial damage: persistent CCD is associated with poor clinical outcome in acute stroke [3]. Lesion's area, not severity, is the main determinant of CCD incidence [4]. Positron emission tomography or perfusion-weighted MRI is used to
Figure 1 Axial diffusion weighted imaging (DWI) MRI. DWI showed high signal intensity in the left fronto-parieto-temporal cortex (white arrows)
Figure 2 Axial apparent diffusion coefficient (ADC) map showed restricted diffusion in corresponding areas (white arrows)
1
tome xx > n8x > xx 2016
LPM-3215
To cite this article: Bailly P, et al. Crossed cerebellar diaschisis in status epilepticus. Presse Med. (2016), http://dx.doi.org/ 10.1016/j.lpm.2016.06.034
Letter to the editor
P. Bailly, A. Bazire, G. Prat, D. Ben Salem
Disclosure of interest: the authors declare that they have no competing interest.
References [1] [2]
[3]
[4]
[5]
Von Monakow C. Die Localization im Grosshirn und der Abbau der Funktion durch korticale Herde. Wiesbaden. Germany: JF Bergmann; 1914. Graffeo CS, Snyder KA, Nasr DM, Murphy ME, Carr CM, Hocker SE. Prognostic and mechanistic factors characterizing seizure-associated crossed cerebellar diaschisis. Neurocrit Care 2016;24:258–63. 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;25:1685–91. Komaba Y, Mishina M, Utsumi K, Katayama Y, Kobayashi S, Mori O. Crossed cerebellar diaschisis in patients with cortical infarction: logistic regression analysis to control for confounding effects. Stroke 2004;35:472–6. Soria N, Meli F, Blumenkrantz Y, Salas E, Turjanski A. Crossed cerebellar diaschisis. Study of a patient by magnetic resonance imaging and positron emission tomography. Rev Neurol 2013;56:425–8. Pierre Bailly1, Amélie Bazire1, Gwenaël Prat1, Douraïed Ben Salem2
Figure 3 Axial DWI MRI. DWI showed high signal intensity in right cerebellar hemisphere (black star)
2
assess the hypoperfusion or hypometabolism in area distant from the original lesion [5]. Diffusion tensor MR imaging can show altered corticocerebellar circuit.
1 Centre hospitalier régional et universitaire de Brest, service de réanimation médicale, boulevard Tanguy-Prigent, 29609 Brest cedex, France 2 Centre hospitalier régional et universitaire de Brest, service de radiologie, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Correspondence: Pierre Bailly, Centre hospitalier régional et universitaire de Brest, service de réanimation médicale, boulevard Tanguy-Prigent, 29609 Brest cedex, France [email protected] Received 10 May 2016 Accepted 6 June 2016 Available online: http://dx.doi.org/10.1016/j.lpm.2016.06.034 © 2016 Elsevier Masson SAS. All rights reserved.
tome xx > n8x > xx 2016
Crossed cerebellar diaschisis in status epilepticus Diaschisis cérébelleux croisé au cours d'un état de mal épileptique
cortex of the left hemisphere (Figures 1 and 2), ipsilateral pulvinar and right cerebellum (Figure 3). Magnetic resonance (MR) angiography showed no vessel occlusion. MRI findings were consistent with focal status epilepticus and crossed cerebellar diaschisis (CCD). Sedation was stopped. Consciousness improved. Patient was discharged from ICU at day 14. Right hemiparesis and aphasia persisted at day 30.
Letter to the editor
en ligne sur / on line on www.em-consulte.com/revue/lpm www.sciencedirect.com
Discussion Case report A 43-year-old man with medical history of alcoholism, diabetes mellitus and head trauma was found unresponsive at home. Physical examination showed apyrexia and a convulsive status epilepticus (SE) without focal signs. Capillary blood glucose was normal. Because of no response to standard treatment regimens for SE, he was sedated, intubated and admitted in ICU. Seizures stopped. Comprehensive laboratory investigations (including lumbar puncture) were negative. EEG performed under sedation found no sign of persistence of SE. Patient was treated with levetiracetam. Brain MRI revealed restricted diffusion within the
CCD was first described in the early twentieth century by Monakow [1]. It can be due to supratentorial stroke, tumours and SE. CCD is due to a hyperactivation–deafferentation phenomenon. It may represent injury caused by excessive neuronal transmission from prolonged excitatory synaptic activity via the cortico-pontine-cerebellar or cortico-thalamic-cerebellar pathways [2]. This leads to loss of function and metabolism, neural depression in the contralateral cerebellum (linked to the injured area) and sometimes neurodegeneration. Its reversibility would be related to the severity of the supratentorial damage: persistent CCD is associated with poor clinical outcome in acute stroke [3]. Lesion's area, not severity, is the main determinant of CCD incidence [4]. Positron emission tomography or perfusion-weighted MRI is used to
Figure 1 Axial diffusion weighted imaging (DWI) MRI. DWI showed high signal intensity in the left fronto-parieto-temporal cortex (white arrows)
Figure 2 Axial apparent diffusion coefficient (ADC) map showed restricted diffusion in corresponding areas (white arrows)
1
tome xx > n8x > xx 2016
LPM-3215
To cite this article: Bailly P, et al. Crossed cerebellar diaschisis in status epilepticus. Presse Med. (2016), http://dx.doi.org/ 10.1016/j.lpm.2016.06.034
Letter to the editor
P. Bailly, A. Bazire, G. Prat, D. Ben Salem
Disclosure of interest: the authors declare that they have no competing interest.
References [1] [2]
[3]
[4]
[5]
Von Monakow C. Die Localization im Grosshirn und der Abbau der Funktion durch korticale Herde. Wiesbaden. Germany: JF Bergmann; 1914. Graffeo CS, Snyder KA, Nasr DM, Murphy ME, Carr CM, Hocker SE. Prognostic and mechanistic factors characterizing seizure-associated crossed cerebellar diaschisis. Neurocrit Care 2016;24:258–63. 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;25:1685–91. Komaba Y, Mishina M, Utsumi K, Katayama Y, Kobayashi S, Mori O. Crossed cerebellar diaschisis in patients with cortical infarction: logistic regression analysis to control for confounding effects. Stroke 2004;35:472–6. Soria N, Meli F, Blumenkrantz Y, Salas E, Turjanski A. Crossed cerebellar diaschisis. Study of a patient by magnetic resonance imaging and positron emission tomography. Rev Neurol 2013;56:425–8. Pierre Bailly1, Amélie Bazire1, Gwenaël Prat1, Douraïed Ben Salem2
Figure 3 Axial DWI MRI. DWI showed high signal intensity in right cerebellar hemisphere (black star)
2
assess the hypoperfusion or hypometabolism in area distant from the original lesion [5]. Diffusion tensor MR imaging can show altered corticocerebellar circuit.
1 Centre hospitalier régional et universitaire de Brest, service de réanimation médicale, boulevard Tanguy-Prigent, 29609 Brest cedex, France 2 Centre hospitalier régional et universitaire de Brest, service de radiologie, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Correspondence: Pierre Bailly, Centre hospitalier régional et universitaire de Brest, service de réanimation médicale, boulevard Tanguy-Prigent, 29609 Brest cedex, France [email protected] Received 10 May 2016 Accepted 6 June 2016 Available online: http://dx.doi.org/10.1016/j.lpm.2016.06.034 © 2016 Elsevier Masson SAS. All rights reserved.
tome xx > n8x > xx 2016