1
|
Guilday C, Hagy H, Lacy M. Cerebellar cognitive affective syndrome with psychotic features in a patient with hypertrophic olivary degeneration. Clin Neuropsychol 2024; 38:235-246. [PMID: 37021325 DOI: 10.1080/13854046.2023.2194675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
Objective: Hypertrophic Olivary Degeneration is a rare condition causing transneuronal degeneration of the inferior olivary nucleus. Symptoms manifest as progressively worsening palatal tremor, ataxia, and eye movement disturbances that plateau after several months. Though rarely documented in the literature of this specific condition, disconnection of the inferior olivary nucleus from the cerebellum, and cerebellar atrophy represent a pathway to developing subsequent cerebellar cognitive affective syndrome. The presented case documents the neuropsychological sequelae of a 39-year-old female with a history of hypertrophic olivary degeneration and symptoms of palatal tremor, opsoclonus myoclonus, ataxia, and delusions. Method: Review of the patient's medical records, interviews with the patient and her father, and a neuropsychological assessment battery were used to collect data. Review of currently published literature lent to case conceptualization. Results: Neuropsychological testing revealed deficits in executive functioning, attention, and language. An anomalous, fixed persecutory delusion was revealed. Conclusion: Hypertrophic olivary degeneration creates disconnection syndromes between the inferior olivary nucleus, red nucleus, and cerebellum. Late stages of the disorder cause atrophy of the inferior olivary nucleus and adjacent structures. While the motor sequela is well documented, the neuropsychological and psychiatric impact is infrequently discussed in existing literature. We present the first case to detail the neuropsychological sequelae of hypertrophic olivary degeneration and propose a mechanism for the development of cognitive impairment and psychotic features within this condition.
Collapse
Affiliation(s)
- Corinne Guilday
- University of Chicago Medical Center, University of Chicago, Chicago, IL, USA
| | - Hannah Hagy
- University of Chicago Medical Center, University of Chicago, Chicago, IL, USA
| | - Maureen Lacy
- University of Chicago Medical Center, University of Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Levinson S, Miller M, Iftekhar A, Justo M, Arriola D, Wei W, Hazany S, Avecillas-Chasin JM, Kuhn TP, Horn A, Bari AA. A structural connectivity atlas of limbic brainstem nuclei. FRONTIERS IN NEUROIMAGING 2023; 1:1009399. [PMID: 37555163 PMCID: PMC10406319 DOI: 10.3389/fnimg.2022.1009399] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/13/2022] [Indexed: 08/10/2023]
Abstract
Background Understanding the structural connectivity of key brainstem nuclei with limbic cortical regions is essential to the development of therapeutic neuromodulation for depression, chronic pain, addiction, anxiety and movement disorders. Several brainstem nuclei have been identified as the primary central nervous system (CNS) source of important monoaminergic ascending fibers including the noradrenergic locus coeruleus, serotonergic dorsal raphe nucleus, and dopaminergic ventral tegmental area. However, due to practical challenges to their study, there is limited data regarding their in vivo anatomic connectivity in humans. Objective To evaluate the structural connectivity of the following brainstem nuclei with limbic cortical areas: locus coeruleus, ventral tegmental area, periaqueductal grey, dorsal raphe nucleus, and nucleus tractus solitarius. Additionally, to develop a group average atlas of these limbic brainstem structures to facilitate future analyses. Methods Each nucleus was manually masked from 197 Human Connectome Project (HCP) structural MRI images using FSL software. Probabilistic tractography was performed using FSL's FMRIB Diffusion Toolbox. Connectivity with limbic cortical regions was calculated and compared between brainstem nuclei. Results were aggregated to produce a freely available MNI structural atlas of limbic brainstem structures. Results A general trend was observed for a high probability of connectivity to the amygdala, hippocampus and DLPFC with relatively lower connectivity to the orbitofrontal cortex, NAc, hippocampus and insula. The locus coeruleus and nucleus tractus solitarius demonstrated significantly greater connectivity to the DLPFC than amygdala while the periaqueductal grey, dorsal raphe nucleus, and ventral tegmental area did not demonstrate a significant difference between these two structures. Conclusion Monoaminergic and other modulatory nuclei in the brainstem project widely to cortical limbic regions. We describe the structural connectivity across the several key brainstem nuclei theorized to influence emotion, reward, and cognitive functions. An increased understanding of the anatomic basis of the brainstem's role in emotion and other reward-related processing will support targeted neuromodulatary therapies aimed at alleviating the symptoms of neuropsychiatric disorders.
Collapse
Affiliation(s)
- Simon Levinson
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- Stanford Department of Neurosurgery, Stanford University, Palo Alto CA, United States
| | - Michelle Miller
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Ahmed Iftekhar
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Monica Justo
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel Arriola
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Wenxin Wei
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Saman Hazany
- Department of Radiology, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | | | - Taylor P. Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Berlin, Germany
- Department of Neurology, Center for Brain Circuit Therapeutics, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
- Massachusetts General Hospital Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ausaf A. Bari
- Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
3
|
Qin C, Liang Y, Tan X, Leng X, Lin H, Zeng H, Zhang C, Yang J, Li Y, Zheng Y, Qiu S. Altered Whole-Brain Functional Topological Organization and Cognitive Function in Type 2 Diabetes Mellitus Patients. Front Neurol 2019; 10:599. [PMID: 31275222 PMCID: PMC6593281 DOI: 10.3389/fneur.2019.00599] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with cognitive dysfunction and may even progress to dementia. However, the underlying mechanism of altered functional topological organization and cognitive impairments remains unclear. This study explored the topological properties of functional whole brain networks in T2DM patients with graph theoretical analysis using a resting-state functional magnetic resonance imaging (rs-fMRI) technique. Thirty T2DM patients (aged 51.77 ± 1.42 years) and 30 sex-, age-, and education-matched healthy controls (HCs) (aged 48.87 ± 0.98 years) underwent resting-state functional imaging in a 3.0 T MR scanner in addition to detailed neuropsychological and laboratory tests. Then, graph theoretical network analysis was performed to explore the global and nodal topological alterations in the functional whole brain networks of the T2DM patients. Finally, correlation analyses were performed to investigate the relationship between the altered topological parameters, cognitive performances and clinical variables. Compared to HCs, we found that T2DM patients displayed worse performances in general cognitive function and several cognitive domains, including episodic memory, attention and executive function. In addition, T2DM patients showed a higher small-worldness (σ), a higher normalized clustering coefficient (γ) and a higher local efficiency (Eloc). Moreover, decreased nodal topological properties were mainly distributed in the occipital lobes, frontal lobes, left median cingulate and paracingulate gyri, and left amygdala, while increased nodal topological properties were mainly distributed in the right gyrus rectus, right anterior cingulate and paracingulate gyri, right posterior cingulate gyrus, bilateral caudate nucleus, bilateral cerebellum 3, bilateral cerebellum crus 1, vermis (1, 2) and vermis 3. Some disrupted nodal topological properties were correlated with cognitive performance and HbA1c levels in T2DM patients. This study shows altered functional topological organization in T2DM patients, mainly suggesting a compensation mechanism of the functional whole brain network in the relatively early stage to counteract cognitive impairments.
Collapse
Affiliation(s)
- Chunhong Qin
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Liang
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Tan
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xi Leng
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huan Lin
- Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Hui Zeng
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chi Zhang
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinquan Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yifan Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanting Zheng
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shijun Qiu
- Department of Radiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
4
|
Jacobs HIL, Hopkins DA, Mayrhofer HC, Bruner E, van Leeuwen FW, Raaijmakers W, Schmahmann JD. The cerebellum in Alzheimer's disease: evaluating its role in cognitive decline. Brain 2019; 141:37-47. [PMID: 29053771 DOI: 10.1093/brain/awx194] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022] Open
Abstract
The cerebellum has long been regarded as essential only for the coordination of voluntary motor activity and motor learning. Anatomical, clinical and neuroimaging studies have led to a paradigm shift in the understanding of the cerebellar role in nervous system function, demonstrating that the cerebellum appears integral also to the modulation of cognition and emotion. The search to understand the cerebellar contribution to cognitive processing has increased interest in exploring the role of the cerebellum in neurodegenerative and neuropsychiatric disorders. Principal among these is Alzheimer's disease. Here we review an already sizeable existing literature on the neuropathological, structural and functional neuroimaging studies of the cerebellum in Alzheimer's disease. We consider these observations in the light of the cognitive deficits that characterize Alzheimer's disease and in so doing we introduce a new perspective on its pathophysiology and manifestations. We propose an integrative hypothesis that there is a cerebellar contribution to the cognitive and neuropsychiatric deficits in Alzheimer's disease. We draw on the dysmetria of thought theory to suggest that this cerebellar component manifests as deficits in modulation of the neurobehavioural deficits. We provide suggestions for future studies to investigate this hypothesis and, ultimately, to establish a comprehensive, causal clinicopathological disease model.
Collapse
Affiliation(s)
- Heidi I L Jacobs
- School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, PO BOX 616, 6200 MD, AQ220 Maastricht, The Netherlands.,Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands.,Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David A Hopkins
- School for Mental Health and Neuroscience, Department of Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands.,Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen C Mayrhofer
- Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands
| | - Emiliano Bruner
- Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
| | - Fred W van Leeuwen
- School for Mental Health and Neuroscience, Department of Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands
| | - Wijnand Raaijmakers
- Faculty of Psychology and Neuroscience, Department of Cognitive Neuroscience, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands
| | - Jeremy D Schmahmann
- Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Goebel S, Mehdorn HM. A missing piece? Neuropsychiatric functioning in untreated patients with tumors within the cerebellopontine angle. J Neurooncol 2018; 140:145-153. [PMID: 29982872 DOI: 10.1007/s11060-018-2944-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To date, little is known about neuropsychiatric symptoms in patients with tumors within the cerebellopontine angle (CPA). These, however, might be of clinical relevance. Aim of this study was thus to assess possible impairment in cognition, elevation in mood symptoms, and fatigue in this specific patient group. METHODS Forty-five patients with an untreated CPA tumor (27 vestibularis schwannoma, 18 meningioma) were tested within a cross-sectional observational study in a single institution prior to neurosurgical treatment. Patients were administered a multifaceted battery comprising of widely-used tests for assessment of neuropsychiatric functioning. RESULTS The majority of the included patients (69%) showed neurocognitive impairment, most frequently in the areas of attention and visuo-motor speed (e.g., alertness) (62%) as well as visuo-construction (44%). Impaired structural integrity of the brain stem was accompanied by more serious neurocognitive deficits. About one-third of the sample reported clinically relevant depression and/or anxiety and an even higher proportion (48%) described high levels of fatigue. Cognitive and affective symptoms as well as fatigue contributed significantly to patients' Quality of Life, indicating the clinical relevance of neuropsychiatric symptoms in patients with CPA tumors. CONCLUSIONS Although patients with untreated CPA tumors often suffer from devastating and prominent physical symptoms, neuropsychiatric problems are also frequent. Including these aspects in the routine clinical assessment and initiating treatment accordingly might thus improve clinical management of the patients and improve Quality of Life.
Collapse
Affiliation(s)
- Simone Goebel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Olshausenstraße 62, 24118, Kiel, Germany.
| | | |
Collapse
|
6
|
Mojtahed Zadeh M, Ashraf-Ganjouei A, Ghazi Sherbaf F, Haghshomar M, Aarabi MH. White Matter Tract Alterations in Drug-Naïve Parkinson's Disease Patients With Impulse Control Disorders. Front Neurol 2018; 9:163. [PMID: 29662464 PMCID: PMC5890183 DOI: 10.3389/fneur.2018.00163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/05/2018] [Indexed: 12/18/2022] Open
Abstract
Impulse control disorders (ICDs) are relatively frequent in patients with Parkinson’s disease (PD), although it is still unclear whether an underlying pathological process plays a significant role in the development of ICD in PD apart from dopaminergic replacement therapy. In this study, we have investigated alterations of white matter tract in drug-naïve PD patients with ICDs via diffusion MRI connectometry. Our results showed that disrupted connectivity in the complex network of dynamic connections between cerebellum, basal ganglia, cortex, and its spinal projections serves as the underlying neuropathology of ICD in PD not interfered with the contribution of dopaminergic replacement therapy. These findings provide the first evidence on involved white matter tracts in the neuropathogenesis of ICD in drug-naïve PD population, supporting the hypothesis that neural disturbances intrinsic to PD may confer an increased risk for ICDs. Future studies are needed to validate the attribution of the impaired corticocerebellar network to impulsivity in PD.
Collapse
Affiliation(s)
- Mahtab Mojtahed Zadeh
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Ghazi Sherbaf
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Haghshomar
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Aarabi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
The Posterior Fossa and Foreign Accent Syndrome: Report of Two New Cases and Review of the Literature. THE CEREBELLUM 2018; 16:772-785. [PMID: 28337694 DOI: 10.1007/s12311-017-0849-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Foreign accent syndrome is a rare motor speech disorder that causes patients to speak their language with a non-native accent. In the neurogenic condition, the disorder develops after lesions in the language dominant hemisphere, often affecting Broca's area, the insula, the supplementary motor area and the primary motor cortex. Here, we present two new cases of FAS after posterior fossa lesions. The first case is a 44-year-old, right-handed, Dutch-speaking man who suffered motor speech disturbances and a left hemiplegia after a pontine infarction. Quantified SPECT showed a bilateral hypoperfusion in the inferior lateral prefrontal and medial inferior frontal regions as well as a significant left cerebellar hypoperfusion. Further clinical investigations led to an additional diagnosis of brainstem cognitive affective syndrome which closely relates to Schmahmann's syndrome. The second patient was a 72-year-old right-handed polyglot English man who suffered a stroke in the vascular territory of the left posterior inferior cerebellar artery (PICA) and developed a foreign accent in his mother tongue (English) and in a later learnt language (Dutch). In this paper, we discuss how the occurrence of this peculiar motor speech disorder can be related to a lesion affecting the posterior fossa structures.
Collapse
|
8
|
In memoriam - Peter Mariën (1962–2017). CEREBELLUM & ATAXIAS 2017. [PMCID: PMC5735944 DOI: 10.1186/s40673-017-0077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
9
|
Bielawski M, Bondurant H. Psychosis following a stroke to the cerebellum and midbrain: a case report. CEREBELLUM & ATAXIAS 2015; 2:17. [PMID: 26664729 PMCID: PMC4673856 DOI: 10.1186/s40673-015-0037-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022]
Abstract
Background There is growing evidence that the cerebellum serves an important role in controlling affect and cognition, and its pathology has been implicated in several psychiatric disorders. Furthermore, the brainstem’s role in cognition and affect has been historically overlooked. Neuroimaging studies and an increasing number of case reports indicate cognitive deficits and hallucinatory phenomena after isolated brainstem lesions. Case presentation We report a 56-year-old man who developed persistent persecutory delusions, hallucinations, cognitive impairment and flattened affect following an extensive bilateral cerebellar stroke with involvement of the midbrain. Conclusions This is one of the few reported cases of unremitting psychosis secondary to cerebellar and mesencephalic vascular infarction. We suggest, based on the distribution of the patient’s lesions, that his corresponding symptoms are a result of a disruption to cerebrocerebellar pathways. This article briefly reviews recent pathophysiological explanations behind the psychosis associated with brainstem and cerebellar lesions, the treatment, as well as the relation of these structures to each other.
Collapse
Affiliation(s)
- Michael Bielawski
- Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Science Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7 Canada
| | - Helen Bondurant
- Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB T5H 3V9 Canada
| |
Collapse
|