Geiser Nora, Kaufmann Brigitte Charlotte, Rühe Henrik, Maaijwee Noortje, Nef Tobias, Cazzoli Dario, Nyffeler Thomas
Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.
ARTORG Center for Biomedical Engineering Research, University of Bern, 3008 Bern, Switzerland.
Brain Sci. 2022 Feb 19;12(2):290. doi: 10.3390/brainsci12020290.
After cerebellar stroke, cognition can be impaired, as described within the framework of the so-called Cerebellar Cognitive Affective Syndrome (CCAS). However, it remains unclear whether visual neglect can also be part of CCAS. We describe the case of a patient with a subacute cerebellar stroke after thrombosis of the left posterior inferior cerebellar artery (PICA), who showed a left-sided visual neglect, indicating that the cerebellum also has a modulatory function on visual attention. The neglect, however, was mild and only detectable when using the sensitive neuro-psychological Five-Point Test as well as video-oculography assessment, yet remained unnoticed when evaluated with common neglect-specific paper-pencil tests. Three weeks later, follow-up assessments revealed an amelioration of neglect symptoms. Therefore, these findings suggest that visual neglect may be a part of CCAS, but that the choice of neglect assessments and the time delay since stroke onset may be crucial. Although the exact underlying pathophysiological mechanisms remain unclear, we propose cerebellar-cerebral diaschisis as a possible explanation of why neglect can occur on the ipsilateral side. Further research applying sensitive assessment tools at different post-stroke stages is needed to investigate the incidence, lesion correlates, and pathophysiology of neglect after cerebellar lesions.
正如在所谓的小脑认知情感综合征（CCAS）框架中所描述的那样，小脑中风后认知可能会受损。然而，目前尚不清楚视觉忽视是否也能成为CCAS的一部分。我们描述了一例因左侧小脑后下动脉（PICA）血栓形成导致亚急性小脑中风的患者，该患者表现出左侧视觉忽视，这表明小脑对视觉注意力也具有调节功能。不过，这种忽视症状较轻，只有在使用敏感的神经心理学五点测试以及视频眼动图评估时才能检测到，而在使用常见的特定于忽视的纸笔测试进行评估时则未被发现。三周后，随访评估显示忽视症状有所改善。因此，这些发现表明视觉忽视可能是CCAS的一部分，但忽视评估的选择以及中风发作后的时间延迟可能至关重要。尽管确切的潜在病理生理机制尚不清楚，但我们提出小脑-大脑失联络作为同侧可能发生忽视的一种解释。需要在中风后的不同阶段应用敏感评估工具进行进一步研究，以调查小脑病变后忽视的发生率、病变相关性和病理生理学。
