Diaschisis cortico-cérébelleux croisé post-état de mal épileptique

Characteristics of cerebral perfusion and diffusion associated with crossed cerebellar diaschisis after acute ischemic stroke

PURPOSE

We aimed to investigate the possible factors associated with the occurrence of crossed cerebellar diaschisis (CCD) at the hyperacute stage of ischemic stroke using whole-brain volume perfusion CT (VPCT) combined with magnetic resonance imaging (MRI).

MATERIALS AND METHODS

We retrospectively analyzed 108 patients with ischemic stroke within 6 h of onset. The VPCT findings of the patients showed a unilateral perfusion deficit in the supratentorial territory. Follow-up MRI examinations were performed within 24 h after onset. The effects of the supratentorial cerebral ischemia, the location distribution, the final infarct volume and the apparent diffusion coefficient (ADC) value on the occurrence and severity of CCD were analyzed.

RESULTS

Among 108 patients with hyperacute cerebral ischemia, 62 (57.4%) demonstrated a contralateral cerebellar perfusion deficit on the VPCT maps. The occurrence of CCD was related to a reduction in cerebral blood volume (CBV) and prolongation of the mean transit time (MTT). Notably, the decrease in the ADC value in the infarct based on follow-up MRI was closely related to the occurrence and severity of CCD.

CONCLUSION

The occurrence and severity of CCD are related to the degree of low supratentorial perfusion and the decrease in the ADC value of infarct focus.

Personality traits related to juvenile myoclonic epilepsy: MRI reveals prefrontal abnormalities through a voxel-based morphometry study

Studies involving juvenile myoclonic epilepsy (JME) patients have demonstrated an elevated prevalence of cluster B personality disorders (PD) characterized as emotional instability, immaturity, unsteadiness, lack of discipline, and rapid mood changes. We aimed to verify a possible correlation between structural brain abnormalities in magnetic resonance image (MRI) and the PD in JME using voxel-based morphometry (VBM). Sixteen JME patients with cluster B PD, 38 JME patients without psychiatric disorders, and 30 healthy controls were submitted to a psychiatric evaluation through SCID I and II and to a MRI scan. Significant reduction in thalami and increase in mesiofrontal and frontobasal regions' volumes were observed mainly in JME patients with PD. Structural alterations of the orbitofrontal cortex (OFC), involved in regulation of mood reactivity, impulsivity, and social behavior, were also observed. This study supports the hypothesis of frontobasal involvement in the pathophysiology of cluster B PD related to JME.