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Crossed Cerebellar Diaschisis Indicates Hemodynamic Compromise in Ischemic Stroke Patients
Lita von Bieberstein1, Christiaan Hendrik Bas van Niftrik2, Martina Sebök2
1Dept. of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
Insights
Crossed cerebellar diaschisis (CCD) in internal carotid artery (ICA) stroke indicates severe hemodynamic impairment. Patients with CCD showed larger BOLD-defined steal volumes, suggesting vascular compromise.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Crossed cerebellar diaschisis (CCD) is linked to internal carotid artery (ICA) stroke, affecting contralateral cerebellar metabolism.
- The exact mechanism of CCD, particularly its vascular component, remains unclear.
Purpose of the Study:
- To investigate if CCD in internal carotid artery occlusion (ICAO) stroke signifies severe hemodynamic impairment.
- To correlate CCD with hemodynamic steal and collateral flow using advanced imaging techniques.
Main Methods:
- Analysis of duplex sonography and blood oxygen-level-dependent MRI cerebrovascular reserve (BOLD-CVR) in 25 stroke patients with unilateral ICAO.
- Inference of CCD presence based on BOLD-CVR, identifying hemodynamic steal.
- Assessment of stroke severity using the National Institute of Health Stroke Scale (NIHSS).
Main Results:
- Eleven patients were CCD+ and 14 were CCD-.
- CCD+ patients exhibited more severe stroke deficits and significantly larger BOLD-defined hemodynamic steal volumes compared to CCD- patients.
- Higher peak-systolic flow velocities in intracranial collateral pathways (ACA/PCA) were observed in CCD+ individuals.
Conclusions:
- CCD in ICAO stroke is a marker of significant hemodynamic impairment and vascular compromise.
- BOLD-CVR and collateral flow assessments are crucial for understanding the vascular component of CCD.
- Findings support the concept of hemodynamic failure contributing to CCD in ICAO stroke.
Abstract:
Crossed cerebellar diaschisis (CCD) in internal carotid artery (ICA) stroke refers to attenuated blood flow and energy metabolism in the contralateral cerebellar hemisphere. CCD is associated with an interruption of cerebro-cerebellar tracts, but the precise mechanism is unknown. We hypothesized that in patients with ICA occlusions, CCD might indicate severe hemodynamic impairment in addition to tissue damage. Duplex sonography and clinical data from stroke patients with unilateral ICAO who underwent blood oxygen-level-dependent MRI cerebrovascular reserve (BOLD-CVR) assessment were analysed. The presence of CCD (either CCD+ or CCD-) was inferred from BOLD-CVR. We considered regions with negative BOLD-CVR signal as areas suffering from hemodynamic steal. Twenty-five patients were included (11 CCD+ and 14 CCD-). Stroke deficits on admission and at 3 months were more severe in the CCD+ group. While infarct volumes were similar, CCD+ patients had markedly larger BOLD steal volumes than CCD- patients (median [IQR] 122.2 [111] vs. 11.6 [50.6] ml; p < 0.001). Furthermore, duplex revealed higher peak-systolic flow velocities in the intracranial collateral pathways. Strikingly, posterior cerebral artery (PCA)-P2 velocities strongly correlated with the National Institute of Health Stroke Scale on admission and BOLD-CVR steal volume. In patients with strokes due to ICAO, the presence of CCD indicated hemodynamic impairment with larger BOLD-defined steal volume and higher flow in the ACA/PCA collateral system. Our data support the concept of a vascular component of CCD as an indicator of hemodynamic failure in patients with ICAO.
