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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(03): 182
DOI: 10.1590/0004-282X20190175
Images in Neurology

Reverse crossed cerebellar diaschisis in status epilepticus: case report

Diásquise cerebelar cruzada relacionada a um estado de mal focal: relato de caso
Marcelo Houat DE BRITO 
1   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Ronnyson Susano GRATIVVOL 
1   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
,
Leandro Tavares LUCATO 
2   Universidade de São Paulo, Hospital das Clínicas, Departamento de Radiologia, São Paulo SP, Brazil.
,
Lécio Figueira PINTO 
1   Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil.
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A 53-year-old female with history of ischemic stroke eleven years before was admitted to the emergency room with recurrent few seconds duration head turning seizures in the past two weeks. Electroencephalogram confirmed focal status epilepticus and Brain MRI disclosed restricted diffusion over left hemisphere regions, together with signs of reverse crossed cerebellar diaschisis ([Figure 1]).

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Figure 1 Axial postcontrast T1-weighted image (A) shows two chronic infarcts (arrows); axial DWI (B and C) demonstrate restricted diffusion in the cerebral cortex in the vicinity of the infarction in the territory of the left middle cerebral artery, due to status epilepticus. The involvement of left thalamic pulvinar (arrow in B) and right cerebellar hemisphere (C), reverse crossed cerebellar diaschisis) can also be noticed. ADC map (D) discloses true cortical restricted diffusion (arrow).

Diaschisis is a transient neuronal shock modality attributable to depression of distant parts of the brain, connected to an injured area[1]. In focal status epilepticus, cerebellar injury is hypothesized to be due to an excessive excitatory neuronal transmission in the cortico-pontine-cerebellar tract[2].


 

Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 Engelhardt E, Gomes MM. Shock, diaschisis and von Monakow. Arq Neuropsiquiatr. 2013 Jul;71(7):487-9. http://dx.doi.org/10.1590/0004-282X20130067
  • 2 Samaniego EA, Stuckert E, Fischbein N, et al. Crossed cerebellar diaschisis in status epilepticus. Neurocrit Care. 2010 Feb;12(1):88-90. https://doi.org/10.1007/s12028-009-9312-y

Address for correspondence

Marcelo Houat de Brito
Departamento de Neurologia / HC-FMUSP; Av. Dr Enéas de Carvalho Aguiar, 255; 05403-000 São Paulo SP
Brazil   

Publication History

Received: 28 August 2019

Accepted: 16 October 2019

Article published online:
02 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Engelhardt E, Gomes MM. Shock, diaschisis and von Monakow. Arq Neuropsiquiatr. 2013 Jul;71(7):487-9. http://dx.doi.org/10.1590/0004-282X20130067
  • 2 Samaniego EA, Stuckert E, Fischbein N, et al. Crossed cerebellar diaschisis in status epilepticus. Neurocrit Care. 2010 Feb;12(1):88-90. https://doi.org/10.1007/s12028-009-9312-y

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Zoom
Figure 1 Axial postcontrast T1-weighted image (A) shows two chronic infarcts (arrows); axial DWI (B and C) demonstrate restricted diffusion in the cerebral cortex in the vicinity of the infarction in the territory of the left middle cerebral artery, due to status epilepticus. The involvement of left thalamic pulvinar (arrow in B) and right cerebellar hemisphere (C), reverse crossed cerebellar diaschisis) can also be noticed. ADC map (D) discloses true cortical restricted diffusion (arrow).