Attig E, Botez M I, Hublet C, Vervonck C, Jacquy J, Capon A
Département de Revalidation Neurologique, Hôpital Brugmann, Bruxelles.
Rev Neurol (Paris). 1991;147(3):200-7.
In 3 patients with a stroke limited to the posterior fossa, regional cerebral blood Flows were measured by the 133 Xe inhalation method (the first two cases) or by the SPECT with HMPAO method (the third case). The first patient had a median and paramedian hematoma of the left cerebellar hemisphere and the left dorsolateral portion of the pons. Remote cerebral hypoperfusion, measured 3 months later, was observed in both frontal premotor regions (but more marked in the right hemisphere) and in a circumscribed area of the right temporal region. The second patient had a right-sided ischaemic lesion of the anterior cerebellar lobe and the mesencephalic tectum. Contralateral parietal and rolandic hypoperfusion, measured 7 weeks after the stroke, was observed. The third patient had on old infarct of the right cerebellar hemisphere. The SPECT, measured 17 years later, showed a left fronto-parieto-temporal hypoperfusion and the absence of perfusion in the right cerebellar hemisphere. Preliminary data of neuropsychological assessment in our patients disclosed impairment in visuo-spatial and constructive organization, memory and learning compatible with the published findings in some patients and animals with predominantly cerebellar damage. These interesting findings should be confirmed in a large number of patients with age, sex, and sociocultural matched controls. In the absence of supratentorial insult, and during the hemodynamical stable phase, crossed cerebello-cerebral diaschisis is suggested in our 3 patients. Although it is too early to draw definite conclusions, our findings may: (1) confirm the functional interconnections between the cerebellum and the cerebrum in man and (2) provide functional basis for the behavioral function impairment reported in patients with cerebellar insult. Further rCBF, metabolism, and pathologic studies on this subject are required to elucidate this issue.
对3例仅累及后颅窝的中风患者，采用133Xe吸入法（前2例）或锝标记六甲基丙二胺肟单光子发射计算机断层扫描（SPECT）法（第3例）测量局部脑血流量。第1例患者左小脑半球及脑桥左背外侧部有中位和旁中位血肿。3个月后测量发现，双侧额前运动区（右侧更明显）及右侧颞叶一局限性区域存在远隔性脑灌注不足。第2例患者右小脑前叶及中脑顶盖有右侧缺血性病变。中风7周后测量发现，对侧顶叶和中央前回灌注不足。第3例患者右小脑半球有陈旧性梗死灶。17年后进行的SPECT检查显示，左侧额顶颞叶灌注不足，右侧小脑半球无灌注。对我们这些患者进行神经心理学评估的初步数据显示，视觉空间和结构组织、记忆及学习方面存在损害，这与一些主要为小脑损伤的患者及动物已发表的研究结果相符。这些有趣的发现应在大量年龄、性别及社会文化背景匹配的对照患者中得到证实。在无幕上损伤且血流动力学稳定阶段，我们的3例患者提示存在交叉性小脑 - 大脑失联络。虽然现在得出明确结论还为时过早，但我们的发现可能：（1）证实人类小脑与大脑之间的功能联系；（2）为小脑损伤患者报告的行为功能损害提供功能基础。需要对此主题进行进一步的局部脑血流量、代谢及病理学研究以阐明这一问题。
