Clinical Research in Stroke
Abderrakib A.a· Ligot N.a· Torcida N.a· Sadeghi Meibodi N.b· Naeije G.aaNeurology Department, Université Libre de Bruxelles – Cliniques Universitaires de Bruxelles – Hôpital Erasme, Bruxelles, Belgium
bRadiology Department, Université Libre de Bruxelles – Cliniques Universitaires de Bruxelles – Hôpital Erasme, Bruxelles, Belgium
Log in to MyKarger to check if you already have access to this content.
Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price. Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more Select* The final prices may differ from the prices shown due to specifics of VAT rules.
Article / Publication DetailsFirst-Page Preview
Received: October 15, 2022
Accepted: December 02, 2022
Published online: January 30, 2023
Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 4
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
AbstractIntroduction: Initial NIHSS in anterior large vessel occlusion (LVO) correlates partially with the hypoperfusion volume. We aimed at assessing the contribution of crossed cerebellar diaschisis (CCD) from the hypoperfused territory on LVO initial clinical deficit. Methods: CCD was retrospectively identified by brain CT perfusion imaging (CTP) in patients with anterior LVO treated by mechanical thrombectomy from January 2017 to July 2021. CCD was defined by CTP parameter alteration in the contralateral cerebellar hemisphere to the LVO. NIHSS, clinical/perfusion variables, and CCD were included in regression models to assess their interrelationships. Results: 206 patients were included. CCD was present in 90 patients (69%). NIHSS scores were higher on admission and at stroke discharge among patients with CCD (17.90 ± 6.1 vs. 11.4 ± 8.4, p < 0.001; 9.6 ± 7.7 vs. 6.6 ± 7.9, p = 0.049; respectively). Patients with a CCD had higher stroke volumes (118.2 ± 60.3 vs. 69.3 ± 59.7, p < 0.001) and lower rate of known atrial fibrillation (22% vs. 41%, p = 0.021). On multivariable logistic regression, CCD independently worsened the initial NIHSS (OR 4.85 [2.37–7.33]; p < 0.001). Conclusion: CCD is found in 69% of LVO on admission CTP, correlates with stroke volumes, and independently worsens initial NIHSS.
© 2023 S. Karger AG, Basel
References National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7. Lyden P. Using the National Institutes of Health Stroke Scale: a cautionary tale. Stroke. 2017;48(2):513–9. Fink JN, Selim MH, Kumar S, Silver B, Linfante I, Caplan LR, et al. Is the association of National Institutes of Health Stroke Scale scores and acute magnetic resonance imaging stroke volume equal for patients with right- and left-hemisphere ischemic stroke? Stroke. 2002;33(4):954–8. Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME. Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Neurology. 1998;50(4):864–70. Woo D, Broderick JP, Kothari RU, Lu M, Brott T, Lyden PD, et al. Does the National Institutes of Health Stroke scale favor left hemisphere strokes? NINDS t-PA stroke study group. Stroke. 1999;30(11):2355–9. Saposnik G, Guzik AK, Reeves M, Ovbiagele B, Johnston SC. Stroke prognostication using age and NIH stroke scale: SPAN-100. Neurology. 2013;80(1):21–8. Ospel JM, Brown S, Kappelhof M, van Zwam W, Jovin T, Roy D, et al. Comparing the prognostic impact of age and baseline National Institutes of Health Stroke scale in acute stroke due to large vessel occlusion. Stroke. 2021;52(9):2839–45. Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31. Finger S, Koehler PJ, Jagella C. The monakow concept of diaschisis origins and perspectives. Arch Neurol. 2004;61(2):283–8. Carrera E, Tononi G. Diaschisis: past, present, future. Brain. 2014;137(Pt 9):2408–22. Dobkin JA, Levine RL, Lagreze HL, Dulli DA, Nickles RJ, Rowe BR. Evidence for transhemispheric diaschisis in unilateral stroke. Arch Neurol. 1989;46(12):1333–6. Lagrèze HL, Levine RL, Pedula KL, Nickles RJ, Sunderland JS, Rowe BR. Contralateral flow reduction in unilateral stroke: evidence for transhemispheric diaschisis. Stroke. 1987;18(5):882–6. Baron JC, D’antona R, Pantano P, Serdaru M, Samson Y, Bousser MG. Effects of thalamic stroke on energy metabolism of the cerebral cortex. A positron tomography study in man. Brain. 1986;109(Pt 6):1243–59. Pappata S, Mazoyer B, Tran Dinh S, Cambon H, Levasseur M, Baron JC. Effects of capsular or thalamic stroke on metabolism in the cortex and cerebellum: a positron tomography study. Stroke. 1990;21(4):519–24. Chu WJ, Mason GF, Pan JW, Hetherington HP, Liu HG, San Pedro EC, et al. Regional cerebral blood flow and magnetic resonance spectroscopic imaging findings in diaschisis from stroke. Stroke. 2002;33(5):1243–8. Sommer WH, Bollwein C, Thierfelder KM, Baumann A, Janssen H, Ertl-Wagner B, et al. Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: occurrence and perfusion characteristics. J Cereb Blood Flow Metab. 2016;36(4):743–54. Pantano P, Baron JC, Samson Y, Bousser MG, Derouesne C, Comar D. Crossed cerebellar diaschisis: further studies. Brain. 1986;109:677–94. Sobesky J, Thiel A, Ghaemi M, Hilker RH, Rudolf J, Jacobs AH, et al. Crossed cerebellar diaschisis in acute human stroke: a PET study of serial changes and response to supratentorial reperfusion. J Cereb Blood Flow Metab. 2005;25(12):1685–91. Baumann O, Borra RJ, Bower JM, Cullen KE, Habas C, Ivry RB, et al. Consensus paper: the role of the cerebellum in perceptual processes. Cerebellum. 2015;14(2):197–220. Kelly RM, Strick PL. Cerebellar loops with motor cortex and prefrontal cortex of a nonhuman primate. J Neurosci. 2003;23:8432–44. Ramnani N. The primate cortico-cerebellar system: anatomy and function. Nat Rev Neurosci. 2006;7:511–22. Infeld B, Davis SM, Lichtenstein M, Mitchell PJ, Hopper JL. Crossed cerebellar diaschisis and brain recovery after stroke. Stroke. 1995;26(1):90–5. Naeije G, Rai M, Allaerts N, Sjogard M, De Tiege X, Pandolfo M. Cerebellar cognitive disorder parallels cerebellar motor symptoms in Friedreich ataxia. Ann Clin Transl Neurol. 2020;7(6):1050–4. Benussi A, Cantoni V, Manes M, Libri I, Dell’Era V, Datta A, et al. Motor and cognitive outcomes of cerebello-spinal stimulation in neurodegenerative ataxia. Brain. 2021;144(8):2310–21. Lin DDM, Kleinman JT, Wityk RJ, Gottesman RF, Hillis AE, Lee AW, et al. Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging. AJNR Am J Neuroradiol. 2009;30(4):710–5. Kunz WG, Sommer WH, Höhne C, Fabritius MP, Schuler F, Dorn F, et al. Crossed cerebellar diaschisis in acute ischemic stroke: impact on morphologic and functional outcome. J Cereb Blood Flow Metab. 2017;37(11):3615–24. Jodaitis L, Ligot N, Chapusette R, Bonnet T, Gaspard N, Naeije G. The hyperdense middle cerebral artery sign in drip-and-ship models of acute stroke management. Cerebrovasc Dis Extra. 2020;10(1):36–43. Ligot N, Elands S, Damien C, Jodaitis L, Sadeghi Meibodi N, Mine B, et al. Stroke core volume weighs more than recanalization time for predicting outcome in large vessel occlusion recanalized within 6 h of symptoms onset. Front Neurol. 2022;13:838192. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18. Elands S, Casimir P, Bonnet T, Mine B, Lubicz B, Sjogard M, et al. Early venous filling following thrombectomy: association with hemorrhagic transformation and functional outcome. Front Neurol. 2021;12:649079. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):e109–37. Knoflach M, Matosevic B, Rücker M, Furtner M, Mair A, Wille G, et al. Functional recovery after ischemic stroke: a matter of age – data from the Austrian Stroke Unit Registry. Neurology. 2012;78(4):279–85. Almekhlafi MA, Davalos A, Bonafe A, Chapot R, Gralla J, Pereira VM, et al. Impact of age and baseline NIHSS scores on clinical outcomes in the mechanical thrombectomy using solitaire FR in acute ischemic stroke study. AJNR Am J Neuroradiol. 2014;35(7):1337–40. Campbell BCV, Majoie CBLM, Albers GW, Menon BK, Yassi N, Sharma G, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol. 2019;18(1):46–55. Olivot J-M, Albucher J-F, Guenego A, Thalamas C, Mlynash M, Rousseau V, et al. Mismatch profile influences outcome after mechanical thrombectomy. Stroke. 2021;52(1):232–40. Henninger N, Goddeau RP, Karmarkar A, Helenius J, McManus DD. Atrial fibrillation is associated with a worse 90-day outcome than other cardioembolic stroke subtypes. Stroke. 2016;47(6):1486–92. Sporns PB, Hanning U, Schwindt W, Velasco A, Minnerup J, Zoubi T, et al. Ischemic stroke: what does the histological composition tell us about the origin of the thrombus? Stroke. 2017;48(8):2206–10. Meneghetti G, Vorstrup S, Mickey B, Lindewald H, Lassen NA. Crossed cerebellar diaschisis in ischemic stroke: a study of regional cerebral blood flow by 133Xe inhalation and single photon emission computerized tomography. J Cereb Blood Flow Metab. 1984;4(2):235–40. Sebök M, van Niftrik CHB, Piccirelli M, Muscas G, Pangalu A, Wegener S, et al. Crossed cerebellar diaschisis in patients with symptomatic unilateral anterior circulation stroke is associated with hemodynamic impairment in the ipsilateral MCA territory. J Magn Reson Imaging. 2021;53(4):1190–7. von Bieberstein L, van Niftrik CHB, Sebök M, El Amki M, Piccirelli M, Stippich C, et al. Crossed cerebellar diaschisis indicates hemodynamic compromise in ischemic stroke patients. Transl Stroke Res. 2021;12(1):39–48. Kamouchi M, Fujishima M, Saku Y, Ibayashi S, Iida M. Crossed cerebellar hypoperfusion in hyperacute ischemic stroke. J Neurol Sci. 2004;225(1–2):65–9. Guglielmi V, LeCouffe NE, Zinkstok SM, Compagne KCJ, Eker R, Treurniet KM, et al. Collateral circulation and outcome in atherosclerotic versus cardioembolic cerebral large vessel occlusion. Stroke. 2019;50(12):3360–8. Rebello LC, Bouslama M, Haussen DC, Grossberg JA, Dehkharghani S, Anderson A, et al. Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes. Eur J Neurol. 2017;24(6):762–7. Gold L, Lauritzen M. Neuronal deactivation explains decreased cerebellar blood flow in response to focal cerebral ischemia or suppressed neocortical function. Proc Natl Acad Sci U S A. 2002;99(11):7699–704. Dettmers C, Hartmann A, Rommel T, Hartmann S, Pappata S, Baron JC. Contralateral cerebellar diaschisis 7 hours after MCA-occlusion in primates. Neurol Res. 1995;17(2):109–12. Pantano P, Lenzi GL, Guidetti B, Di Piero V, Gerundini P, Savi AR, et al. Crossed cerebellar diaschisis in patients with cerebral ischemia assessed by SPECT and 123I-HIPDM. Eur Neurol. 1987;27(3):142–8. Miura H, Nagata K, Hirata Y, Satoh Y, Watahiki Y, Hatazawa J. Evolution of crossed cerebellar diaschisis in middle cerebral artery infarction. J Neuroimaging. 1994;4(2):91–6. Kim Y, Lim SH, Park GY. Crossed cerebellar diaschisis has an adverse effect on functional outcome in the subacute rehabilitation phase of stroke: a case-control study. Arch Phys Med Rehabil. 2019;100(7):1308–16. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med. 2018;378(17):1573–82. Abderrakib A, Torcida N, Sadeghi N, Naeije G. Crossed cerebellar diaschisis worsens the clinical presentation in acute large vessel occlusion. 2022. Article / Publication DetailsFirst-Page Preview
Received: October 15, 2022
Accepted: December 02, 2022
Published online: January 30, 2023
Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 4
ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)
For additional information: https://www.karger.com/CED
Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Comments (0)