Anatomical correlate of impaired covert visual attentional processes in patients with cerebellar lesions

In the past years, claims of cognitive and attentional function of the cerebellum have first been raised but were later refuted. One reason for this controversy might be that attentional deficits only occur when specific cerebellar structures are affected. To further elucidate this matter and to determine which cerebellar regions might be involved in deficits of covert visual attention, we used new brain imaging tools of lesion mapping that allow a direct comparison with control patients. A total of 26 patients with unilateral right-sided cerebellar infarcts were tested on a covert visual attention task. Eight (31%) patients showed markedly slowed responses, especially in trials in which an invalid cue necessitated reorienting of the focus of attention for target detection. Compared with the 18 patients who performed within the range of healthy control subjects, only the impaired patients had lesions of cerebellar vermal structures such as the pyramid. We suggest that these midcerebellar regions are indirectly involved in covert visual attention via oculomotor control mechanisms. Thus, specific cerebellar structures do influence attentional orienting, whereas others do not.