Non epileptic absence seizures and cognitive outcomes after cerebellar stroke in vermis and posterior lobe

Cerebellar Cognitive Affective Syndrome (CCAS) is traditionally characterized by impairments in executive functioning, visuospatial processing, language, and affective regulation. Classic descriptions emphasize symptoms such as irritability, apathy, depression, and disinhibited behaviors, frequently associated with vermian or hemispheric cerebellar lesions. We describe a case that diverges from these classical profiles.

A case report shows that patient demonstrated preserved overall cognition and absence seizures with context-dependent emotional dysregulation, while maintaining a generally stable mood during hospitalization. This pattern suggests that cerebellar lesions may present with heterogeneous cognitive - affective profiles and do not always conform to established CCAS criteria. These findings raise important considerations for clinical interpretation of the CCAS Scale, particularly when accounting for individual variability and contextual influences.

The case prompts reflection on the traditional view of the vermis in emotional regulation. Although vermian lesions have often been linked to affective disturbances such as irritability, apathy, and emotional lability, our patient largely maintained appropriate emotional regulation despite vermian involvement.

This observation supports the possibility that vermian-related emotional or behavioral changes may be context-dependent and modulated by situational or environmental factors. A more nuanced understanding of CCAS presentations may enhance diagnostic accuracy and improve care for patients with cerebellar injury.