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NEUROLOGY 2009;72:e79
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: Diaschisis

Is it always reversible? Neeraj N. Baheti, MD, Atma Ram Bansal, MD, Chaturbhuj Rathore, MD and Chandrasekhar Kesavdas, MD

From the Departments of Neurology (N.N.B., A.R.B., C.R.) and Imaging Sciences & Interventional Radiology (C.K.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Address correspondence and reprint requests to Dr. C. Rathore, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum–695 011, Kerala, India cbrathore{at}rediffmail.com

A 17-year-old boy presented with left focal seizures and progressive hemiparesis for 10 years. Serial MRIs showed progressive right cerebral and contralateral cerebellar atrophy (figure). He is seizure-free after right hemispherotomy. Pathology was compatible with Rasmussen encephalitis.


Figure 118
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  		Figure Brain MRI (1.5 T)

(A–C) Brain MRI (1997): Axial (A, B) and coronal (C) T2-weighted fast spin echo images show atrophy of the right cerebral and left cerebellar hemispheres. (D–F) MRI (2007): Corresponding axial (D, E) and coronal (F) T2-weighted fast spin echo images show the progression of atrophy of the left cerebellar hemisphere, right cerebral peduncle, and right cerebral hemisphere. (G–I) MRI (2008): Images (G–I) 1 year after hemispherotomy show no further progression of cerebellar atrophy.

 

Crossed cerebellar diaschisis and subsequent crossed cerebellar atrophy, due to supratentorial lesions or chronic focal seizures, represents the best evidence of transneuronal depression in humans.1 Contrary to the original concept of reversible dysfunction in diaschisis,2 distant areas may undergo irreversible degeneration depending upon the nature of the primary process. Progressive crossed cerebellar atrophy has been mainly reported with conditions associated with chronic focal seizures,1 presumably related to additional transneuronal excitotoxic damage.

Disclosure: The authors report no disclosures.


   REFERENCES
Top.
 REFERENCES
 

  1. Tien RD, Ashdown BC. Crossed cerebellar diaschisis and crossed atrophy: correlation of MR findings, clinical symptoms, and supratentorial diseases in 26 patients. AJR Am J Roentgenol 1992;158:1155–1159.[Abstract/Free Full Text]
  2. Finger S, Koehler PJ, Jagella C. The Monakow concept of diaschisis. Arch Neurol 2004;61:283–288.[Abstract/Free Full Text]




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Right arrow MRI
Right arrow Encephalitis
Right arrow All Clinical Neurology
Right arrow All Epilepsy/Seizures
Right arrow Partial seizures