Cognitive, linguistic and affective disturbances following a right superior cerebellar artery infarction: A case study
Cognitive, linguistic and affective disturbances following a right superior cerebellar artery infarction: A case study
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DOI：
10.1016/j.cortex.2007.12.010
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发表时间：
2009-04-01
期刊：
影响因子：
3.6
通讯作者：
De Deyn, Peter P.
中科院分区：
文献类型：
--
作者：
Marien, Peter;Baillieux, Hanne;De Deyn, Peter P.
小脑认知情感综合征（CCAS）是一种神经行为综合征，可能发生于先天性和后天性小脑损伤后。该综合征包括执行功能，空间认知，视觉空间记忆和语言的缺陷，还涉及个性和行为变化。我们描述了一个58岁的右利手的男子谁除了情感障碍提出了一个独特的组合认知和语言缺陷后，缺血性梗死的血管领土的右上级小脑动脉（SCA）。在卒中急性期（发病后10天）和病变期（发病后4周）进行神经认知和神经语言学检查。在中风后五周进行了Tc-99m-ECD SPECT研究。急性期数据显示，广泛的认知能力下降和轻度经皮质感觉失语症。在病变阶段，神经行为的画面主要是执行功能障碍，分散注意力，扰乱视觉空间组织和行为异常。神经语言学研究发现视觉阅读障碍和表面书写困难。阅读词和视觉词汇判断任务的词和非词的严重缺陷，主要特点是视觉错误。此外，书写不规则和模糊的单词会导致规则化错误（基于音素-字形对应规则的语音上合理的错误）。在幕上脑区没有任何结构损伤的情况下，定量SPECT研究显示右小脑半球和左内侧额叶相对灌注不足。CCAS是第一次报告与视觉阅读障碍和表面书写困难。我们推测，认知和语言缺陷可能是由于小脑-脑通路的功能中断，小脑连接到额叶幕上区，这有助于注意力和规划过程。这种交叉小脑-大脑神经联系不能的现象得到了SPECT结果的支持，该结果显示在解剖学临床怀疑的大脑区域存在灌注不足。认知，语言和行为症状的星座为小脑神经认知的多方面领域提供了新的证据，并表明小脑可能在认知，语言和情感处理中发挥关键作用。(C)2008 Elsevier Srl. All rights reserved.
The cerebellar cognitive affective syndrome (CCAS) is a neurobehavioral syndrome that may develop after congenital and acquired cerebellar lesions. The syndrome consists of deficits in executive functioning, spatial cognition, visual-spatial memory and language and also involves personality and behavioral changes. We describe a 58-year-old right-handed man who in addition to affective disturbances presented with a unique combination of cognitive and linguistic deficits following an ischemic infarction in the vascular territory of the right superior cerebellar artery (SCA). Neurocognitive and neurolinguistic examinations were performed in the acute phase (10 days post-onset) and lesion phase (four weeks post-onset) of the stroke. A Tc-99m-ECD SPECT study was performed five weeks after the stroke. Acute phase data revealed a generalized cognitive decline and mild transcortical sensory aphasia. In the lesion phase, the neurobehavioral tableau was dominated by executive dysfunctions, disrupted divided attention, disturbed visual-spatial organization and behavioral abnormalities. Neurolinguistic investigations disclosed visual dyslexia and surface dysgraphia. Reading of words and visual lexical decision tasks of words and nonwords were severely defective and predominantly characterized by visual errors. in addition, writing irregular and ambiguous words resulted in regularization errors (phonologically plausible errors based on phoneme-grapheme correspondence rules). In the absence of any structural damage in the supratentorial brain regions, a quantified SPECT study showed a relative hypoperfusion in the right cerebellar hemisphere and the left medial frontal lobe. CCAS is for the first time reported in association with visual dyslexia and surface dysgraphia. We hypothesize that the cognitive and linguistic deficits might result from functional disruption of the cerebellar-encephalic pathways, connecting the cerebellum to the frontal supratentorial areas which subserve attentional and planning processes. This phenomenon of crossed cerebellar-cerebral diaschisis is supported by SPECT findings revealing a hypoperfusion in the anatomoclinically suspected brain regions. The constellation of cognitive, linguistic and behavioral symptoms adds new evidence to the multifaceted area of cerebellar neurocognition and demonstrates that the cerebellum might play a crucial role in cognitive, linguistic, and affective processing. (C) 2008 Elsevier Srl. All rights reserved.