Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1994 Feb;57(2):174–179. doi: 10.1136/jnnp.57.2.174

Contralateral cerebellar hypometabolism: a predictor for stroke outcome?

C Serrati 1, G Marchal 1, P Rioux 1, F Viader 1, M C Petit-Taboué 1, P Lochon 1, D Luet 1, J M Derlon 1, J C Baron 1
PMCID: PMC1072444  PMID: 8126499

Abstract

Contralateral cerebellar hypometabolism (CCH) is a well established remote functional effect of cerebral damage. Because CCH has been reported to be reversible in acute stroke in at least some patients, the value of cerebellar metabolic asymmetry (CbMA; a reflection of the degree of CCH) as a predictor of stroke outcome has been assessed. Measurements of cerebellar oxygen consumption were performed by positron emission tomography (PET) in 16 patients within 5-30 hours of onset of their first ever middle cerebral artery territory stroke, and again 13-56 days later in 12 survivors. The neurological state was quantified at the time of each PET study and at day 60, with both the Mathew and Orgogozo scales. In the early PET study, the CbMAs ranged from around 0% to nearly 50% (individually significant at p < 0.05 in 9/16 patients) but were neither strongly nor consistently correlated with neurological outcome or recovery at day 60. Similarly, the changes in CbMAs from the early to the late PET study were not correlated with the concomitant neurological evolution. At the late PET study, however, there were excellent positive correlations between CbMAs and both neurological status and size of infarction (assessed by CT in the chronic stage). The correlation with neurological status was explained by the correlation with size of infarction. The poor predictive value of CbMAs in the early PET study may be partly because the cerebral metabolic disturbance might still be evolving at this early stage in some cases. Despite this lack of a strong quantitative link between CbMAs at the early PET study and outcome, the outcome was good in all the patients who did not exhibit significant CCH, suggesting that lack of CCH may predict good outcome in acute middle cerebral artery stroke.

Full text

PDF
174

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brunberg J. A., Frey K. A., Horton J. A., Kuhl D. E. Crossed cerebellar diaschisis: occurrence and resolution demonstrated with PET during carotid temporary balloon occlusion. AJNR Am J Neuroradiol. 1992 Jan-Feb;13(1):58–61. [PMC free article] [PubMed] [Google Scholar]
  2. Fox P. T., Perlmutter J. S., Raichle M. E. A stereotactic method of anatomical localization for positron emission tomography. J Comput Assist Tomogr. 1985 Jan-Feb;9(1):141–153. doi: 10.1097/00004728-198501000-00025. [DOI] [PubMed] [Google Scholar]
  3. Frackowiak R. S., Lenzi G. L., Jones T., Heather J. D. Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure, and normal values. J Comput Assist Tomogr. 1980 Dec;4(6):727–736. doi: 10.1097/00004728-198012000-00001. [DOI] [PubMed] [Google Scholar]
  4. Heiss W. D. Experimental evidence of ischemic thresholds and functional recovery. Stroke. 1992 Nov;23(11):1668–1672. doi: 10.1161/01.str.23.11.1668. [DOI] [PubMed] [Google Scholar]
  5. Jenkins W. M., Merzenich M. M. Reorganization of neocortical representations after brain injury: a neurophysiological model of the bases of recovery from stroke. Prog Brain Res. 1987;71:249–266. doi: 10.1016/s0079-6123(08)61829-4. [DOI] [PubMed] [Google Scholar]
  6. Kurthen M., Reichmann K., Linke D. B., Biersack H. J., Reuter B. M., Durwen H. F., Grünwald F. Crossed cerebellar diaschisis in intracarotid sodium amytal procedures: a SPECT study. Acta Neurol Scand. 1990 May;81(5):416–422. doi: 10.1111/j.1600-0404.1990.tb00987.x. [DOI] [PubMed] [Google Scholar]
  7. Kushner M., Alavi A., Reivich M., Dann R., Burke A., Robinson G. Contralateral cerebellar hypometabolism following cerebral insult: a positron emission tomographic study. Ann Neurol. 1984 May;15(5):425–434. doi: 10.1002/ana.410150505. [DOI] [PubMed] [Google Scholar]
  8. Lammertsma A. A., Baron J. C., Jones T. Correction for intravascular activity in the oxygen-15 steady-state technique is independent of the regional hematocrit. J Cereb Blood Flow Metab. 1987 Jun;7(3):372–374. doi: 10.1038/jcbfm.1987.75. [DOI] [PubMed] [Google Scholar]
  9. Lammertsma A. A., Jones T. Correction for the presence of intravascular oxygen-15 in the steady-state technique for measuring regional oxygen extraction ratio in the brain: 1. Description of the method. J Cereb Blood Flow Metab. 1983 Dec;3(4):416–424. doi: 10.1038/jcbfm.1983.67. [DOI] [PubMed] [Google Scholar]
  10. Lebrun-Grandié P., Baron J. C., Soussaline F., Loch'h C., Sastre J., Bousser M. G. Coupling between regional blood flow and oxygen utilization in the normal human brain. A study with positron tomography and oxygen 15. Arch Neurol. 1983 Apr;40(4):230–236. doi: 10.1001/archneur.1983.04050040060010. [DOI] [PubMed] [Google Scholar]
  11. Marchal G., Rioux P., Petit-Taboué M. C., Sette G., Travère J. M., Le Poec C., Courtheoux P., Derlon J. M., Baron J. C. Regional cerebral oxygen consumption, blood flow, and blood volume in healthy human aging. Arch Neurol. 1992 Oct;49(10):1013–1020. doi: 10.1001/archneur.1992.00530340029014. [DOI] [PubMed] [Google Scholar]
  12. Martínez-Vila E., Guillén F., Villanueva J. A., Matías-Guiu J., Bigorra J., Gil P., Carbonell A., Martínez-Lage J. M. Placebo-controlled trial of nimodipine in the treatment of acute ischemic cerebral infarction. Stroke. 1990 Jul;21(7):1023–1028. doi: 10.1161/01.str.21.7.1023. [DOI] [PubMed] [Google Scholar]
  13. Mathew N. T., Rivera V. M., Meyer J. S., Charney J. Z., Hartmann A. Double-blind evaluation of glycerol therapy in acute cerebral infarction. Lancet. 1972 Dec 23;2(7791):1327–1329. doi: 10.1016/s0140-6736(72)92775-4. [DOI] [PubMed] [Google Scholar]
  14. Meneghetti G., Vorstrup S., Mickey B., Lindewald H., Lassen N. A. Crossed cerebellar diaschisis in ischemic stroke: a study of regional cerebral blood flow by 133Xe inhalation and single photon emission computerized tomography. J Cereb Blood Flow Metab. 1984 Jun;4(2):235–240. doi: 10.1038/jcbfm.1984.32. [DOI] [PubMed] [Google Scholar]
  15. Orgogozo J. M., Capildeo R., Anagnostou C. N., Juge O., Péré J. J., Dartigues J. F., Steiner T. J., Yotis A., Rose F. C. Mise au point d'un score neurologique pour l'évaluation clinique des infarctus sylviens. Presse Med. 1983 Dec 29;12(48):3039–3044. [PubMed] [Google Scholar]
  16. Pantano P., Baron J. C., Crouzel C., Collard P., Sirou P., Samson Y. The 15O continuous-inhalation method: correction for intravascular signal using C15O. Eur J Nucl Med. 1985;10(9-10):387–391. doi: 10.1007/BF00256576. [DOI] [PubMed] [Google Scholar]
  17. Pantano P., Baron J. C., Samson Y., Bousser M. G., Derouesne C., Comar D. Crossed cerebellar diaschisis. Further studies. Brain. 1986 Aug;109(Pt 4):677–694. doi: 10.1093/brain/109.4.677. [DOI] [PubMed] [Google Scholar]
  18. Pappata S., Mazoyer B., Tran Dinh S., Cambon H., Levasseur M., Baron J. C. Effects of capsular or thalamic stroke on metabolism in the cortex and cerebellum: a positron tomography study. Stroke. 1990 Apr;21(4):519–524. doi: 10.1161/01.str.21.4.519. [DOI] [PubMed] [Google Scholar]
  19. Perani D., Gerundini P., Lenzi G. L. Cerebral hemispheric and contralateral cerebellar hypoperfusion during a transient ischemic attack. J Cereb Blood Flow Metab. 1987 Aug;7(4):507–509. doi: 10.1038/jcbfm.1987.95. [DOI] [PubMed] [Google Scholar]
  20. Sette G., Baron J. C., Mazoyer B., Levasseur M., Pappata S., Crouzel C. Local brain haemodynamics and oxygen metabolism in cerebrovascular disease. Positron emission tomography. Brain. 1989 Aug;112(Pt 4):931–951. doi: 10.1093/brain/112.4.931. [DOI] [PubMed] [Google Scholar]
  21. Tanaka M., Kondo S., Hirai S., Ishiguro K., Ishihara T., Morimatsu M. Crossed cerebellar diaschisis accompanied by hemiataxia: a PET study. J Neurol Neurosurg Psychiatry. 1992 Feb;55(2):121–125. doi: 10.1136/jnnp.55.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Yamauchi H., Fukuyama H., Yamaguchi S., Doi T., Ogawa M., Ouchi Y., Kimura J., Sadatoh N., Yonekura Y., Tamaki N. Crossed cerebellar hypoperfusion in unilateral major cerebral artery occlusive disorders. J Nucl Med. 1992 Sep;33(9):1637–1641. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES