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 co-ordination of movement, there is recent evidence that it is also involved in cognitive functions such as language and memory. Language disorder, impairment of visuospatial cognition, impairment of executive function and mood changes are reported in association with tumours and vascular disorder of the cerebellum. This pathological condition, reported and named the ‘cerebellar cognitive affective syndrome (CCAS)’ by Schmahmann et al. , is considered to result from damage in the neural circuit that links the cerebellum with the cerebral cortex. While there are reports of cases with this pathological condition, there have been almost no reports of CCAS from the viewpoint of rehabilitation therapy.
The present paper reports a case of CCAS after cerebellar haemorrhage.
Case report The patient was a 61-year-old right-handed man with 12 years of educational history. On 24 October 2005, when he was gardening, he was struck by sudden headache, vomiting and vertigo. A diagnosis of cerebellar haemorrhage was made by a nearby physician and the man received craniotomy for haematoma evacuation. Due to obstructive hydrocephaly that developed after the operation, ventricular drainage was also performed. Ventricular dilatation or convulsion was not found during hospitalization.
Correspondence: Shinichiro Maeshima, MD, PhD, Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-City, Saitama 350-1298, Japan. E-mail: firstname.lastname@example.org ISSN 0269–9052 print/ISSN 1362–301X online ß 2007 Informa UK Ltd. DOI: 10.1080/02699050701504273
S. Maeshima & A. Osawa having played with his grandchild prior to disease. No confabulation was found. In the digit span test, the patient could repeat 8 digits forward but only 2 digits backward. He scored 23/30 in the MiniMental State Examination (MMSE), with declining performance in orientation, attention and calculation and reproduction. The WAIS-R scores were VIQ ¼...