From the Department of Neurosurgery (M.I., S.O., S.H.), and Department of Neurology (T.Y., T.T.), Saitama Medical Center, Kawagoe, Japan.
Neurology. 2023 Sep 19;101(12):e1272-e1275. doi: 10.1212/WNL.0000000000207509. Epub 2023 Jul 5.
The primary function of the cerebellum is the coordination and regulation of movement; therefore, cerebellar tumors usually present with ataxia, dysarthria, and vertigo. Large tumors also cause elevated intracranial pressure that may lead to a disturbance of consciousness. Furthermore, it has become increasingly evident that the cerebellum plays a substantial role in cognitive and affective processing. A 44-year-old female patient presented with a 1-month history of depression and flat affect. She had no cerebellar symptoms including no coordination dysfunction or dysarthria. Cognitive function tests revealed impairments in attention, execution, and processing speed. Hamilton Depression Scale and Hospital Anxiety Depression Scale indicated moderate-to-severe depression. Magnetic resonance (MR) imaging revealed a 7-mm enhancing lesion in the culmen of the cerebellar vermis with surrounding edema. Technetium-99m ethyl cysteinate dimer single-photon emission tomography (SPECT) showed hypoperfusion in the left frontal lobe. Although she was initially treated with corticosteroids for presumed sero-negative autoimmune encephalitis, her symptoms persisted. She then underwent cerebellar lesion resection. The histologic diagnosis was hemangioblastoma. The patient's symptoms dramatically improved within 1 week of resection, including improved batteries for cognitive function and depression. Complete regression of cerebellar edema and left frontal lobe hypoperfusion was observed on MR and SPECT images, respectively. This case reiterates the crucial influence of the cerebellum on cognitive and affective function. Moreover, cognitive dysfunction may be masked in cases with focal cerebellar symptoms or elevated intracranial pressure and, consequently, not adequately evaluated.
小脑的主要功能是协调和调节运动；因此，小脑肿瘤通常表现为共济失调、构音障碍和眩晕。大的肿瘤也会导致颅内压升高，可能导致意识障碍。此外，越来越明显的是，小脑在认知和情感处理中起着重要的作用。一名 44 岁女性患者因 1 个月的抑郁和表情平淡而就诊。她没有小脑症状，包括无协调功能障碍或构音障碍。认知功能测试显示注意力、执行力和处理速度受损。汉密尔顿抑郁量表和医院焦虑抑郁量表表明中重度抑郁。磁共振成像（MR）显示小脑蚓部 culmen 有 7mm 增强病变，伴有周围水肿。锝-99m 乙撑二半胱氨酸二聚体单光子发射断层扫描（SPECT）显示左额叶灌注不足。尽管她最初因疑似血清阴性自身免疫性脑炎而接受皮质类固醇治疗，但她的症状持续存在。随后她接受了小脑病变切除术。组织学诊断为血管母细胞瘤。切除后患者的症状在 1 周内显著改善，包括认知功能和抑郁的改善。MR 和 SPECT 图像分别显示小脑水肿和左额叶灌注不足完全消退。本例再次强调了小脑对认知和情感功能的重要影响。此外，在有局灶性小脑症状或颅内压升高的情况下，认知功能障碍可能被掩盖，因此评估不充分。
