Stroke Rehabilitation in a Patient with Cerebellar Cognitive Affective Syndrome

Brain Injury, July 2007; 21(8): 877–883

CASE REPORT

Stroke rehabilitation in a patient with cerebellar cognitive affective syndrome

SHINICHIRO MAESHIMA & AIKO OSAWA
Department of Rehabilitation Medicine, Kawasaki Medical School, Kawasaki Hospital, Japan
Brain Inj Downloaded from informahealthcare.com by University of Toronto on 01/24/12 For personal use only.

(Received 1 August 2006; accepted 11 June 2007)

Abstract Objective: It has become evident that the cerebellum plays a role in cognitive function, and Schmahmann et al. have introduced the term ‘‘Cerebellar cognitive affective syndrome (CCAS).’’ In the present paper we report a patient with cerebellar hemorrhage who developed CCAS. Design: A case study. Methods: The patient was a 61-year-old right-handed man who was admitted to our hospital because of sudden headache, dizziness and vomiting. The patient showed ataxia of the trunk and the extremities, but no paralysis and disturbance of sensation. He was disoriented in time and showed recent memory disturbance, disturbance of attention, impairment of executive functions and reduced volition, and due to these symptoms, his daily living was also severely impaired. Results: With the aim of returning home, the patient received exercise therapy and cognitive rehabilitation, while home modification was performed, and living at home under the supervision of his family became possible. Cognitive function improved, while memory and attention disturbance, impairment of executive function remained. Conslusion: Cognitive dysfunction in patients with cerebellar damage is assumed to develop from disturbance of the cerebrocerebellar circuit, and that rehabilitation of these patients must include assessment of not only the motor function, but also of detailed assessment of cerebral function. Keywords: Cerebellum, cognition, rehabilitation, diaschisis

Introduction While it is established that the cerebellum is a neural structure responsible for the

References: 1. Schmahmann JD, Sheman JC. The cerebellar cognitive affective syndrome. Brain 1998;121:561–579. 2. Sohlberg MM, Mateer CA. Effectiveness of an attentiontraining program. Journal of Clinical and Experimental Neuropsychology 1987;9:117–130. 3. Kish SJ, el-Awar M, Scht L, Leach L, Oscar-Berman M, Freedman M. Cognitive deficits in olivopontocerebellar atrophy: Implications for the cholinergic hypothesis of Alzheimer’s dementia. Annals of Neurology 1988;24:200–206. 4. Grafman J, Litcan I, Massaquoi S, Stewart, Sirigu A, Hallett M. Cognitive planning deficit in patients with cerebellar atrophy. Neurology 1992;42:1493–1496. 5. Appollonio IM, Grafman J, Schwartz V, Massaquoi S, Haltt M. Memory in patients with cerebellae degeneration. Neurology 1993;43:1536–1544. 6. Wallesch C-W, Horn A. Long-term effects of cerebellar pathology on cognitive functions. Brain Cognition 1990; 14:19–25. 7. Kingma A, Mooij JJ. Metzemaekers JD, Leeuw JA. Transient mutism and speech disorders after posterior fossa surgery in children with brain tumors. Acta Neurochirgia (Wein) 1994;131:74–79. 8. Pollack IF, Polinko P, Albright AL, Towbin R, Fitz C. Mutism and pseudobulbar symptoms after resection of posterior fossa tumors in children: incidence and pathophysiology. Neurosurgery 1995;37:885–893. 9. Silveri MC, Leggio MG, Molinari M. The cerebellum contributes to linguistic production: A case of agrammatic speech following a right cerebellar lesion. Neurology 1994;44:2047–2050. 10. Gottwald B, Wilde B, Mihajlovic Z, Mehdorn HM. Evidence for distinct cognitive deficits after focal cerebellar lesions. Journal of Neurology, Neurosurgery and Psychiatry 2004;64:500–503. 11. Middleton FA, Strick PL. Anatomical evidence for cerebellar and basal ganglia involvement in higher cognitive function. Science 1994;266:458–461. Stroke rehabilitation in a patient with CCAS 12. Sonmezoglu K, Sperling B, Henriksen T, Tfelt-Hansen P, Lassen NA. Reduced contralateral hemispheric flow measured by SPECT in cerebellar lesions: Crossed cerebral diaschisis. Acta Neurologica Scandinavica 1993;87: 275–280. 13. Hubrich-Ungureanu P, Kaemmerer N, Henn FA, Braus DF. Lateralized organization of the cerebellum in a silent verbal fluency task: A functional magnetic resonance imaging study in healthy volunteers. Neuroscience Letters 2002;319: 91–94. 883 14. Someya F, Tachino K, Kagechika K. Evaluation for physical recovery of patients with cerebellar stroke. Sogo Rehabilitation (Tokyo) 1997;25:743–747. 15. Kelly PJ, Stein J, Shafqat S, Eskey C, Docherty D, Chang Y, Kurina A, Furie KL. Functional recovery after rehabilitation for Cerebellar stroke. Stroke 2001;32:530–534. 16. Kudo Y, Nakano A, Sato A, Imamura T, Sato Y. Cognitive, affective and behavioral disturbances due to cerebellar hemorrhage: Inhibitory factors for rehabilitation. Japanese Journal of Rehabilitation Medicine 2005;42:463–468. Brain Inj Downloaded from informahealthcare.com by University of Toronto on 01/24/12 For personal use only.