Cerebellar diaschisis in pontine infarctions: a report of five cases

We evaluate regional cerebral and cerebellar perfusion to prove the occurrence and follow the persistence of crossed cerebellar diaschisis in infratentorial pontine infarction. Six consecutive patients exhibiting mild hemiparetic symptoms or a heavy feeling in the head (mean age 65 years; four women, two men) and diagnosed as having pontine infarction by magnetic resonance imaging were subjected to evaluation. Lesions due to infarction were located at the upper basis pontis in five patients and the upper tegmentum pontis in one, and medially at the paramedian portion in four and laterally in two. Regional cerebral and cerebellar perfusion was evaluated semiquantitatively by iodine-123 N-isopropyl-p-iodoamphetamine (IMP) single-photon emission tomography (SPET); this was done during the acute stage in five cases (mean time after onset: 0.7 months) and during the chronic stage in three (mean time after onset: 14.8 months). Four patients had two examinations during their clinical courses. For semiquantitative evaluation of perfusion, an asymmetry index was calculated for each region of interest, set symmetrically in regions of the cerebral cortex and cerebellum in both hemispheres. Significant asymmetry (P < 0.01) in cerebellar perfusion, which was reduced in the contralateral (n = 4) or ipsilateral (n = 1) cerebellar hemisphere, was demonstrated semiquantitatively in four cases during the acute stage and in one during the chronic stage, as compared with normal controls (n = 5, mean age 61 years). This asymmetry continued to the chronic stage (6.5 and 33.0 months) in two cases, while no patient showed any significant asymmetries in cerebral perfusion in any region of interest in either SPET study.(ABSTRACT TRUNCATED AT 250 WORDS)