Crossed cerebellar diaschisis in herpes simplex encephalitis
Introduction
Diaschisis designates a phenomenon that immediate decrease in regional neuronal activity due to an interruption of its afferent axonal input [1]. It has been extended to describe a condition that decreased cerebral blood flow and metabolism in a structurally normal brain distant from the site of cerebral ischemia [2]. Diaschisis may occur in the cerebellum contralateral to the supratentorial brain infarction and is called ‘crossed cerebellar diaschisis’ (CCD) [3]. We herein described CCD on Technetium-99m ethyl cysteinate dimer (99mTc-ECD) brain single-photon emission computed tomography (SPECT) that occurs in the setting of acute herpes simplex type 1 (HSV-1) encephalitis. The possible mechanism of CCD was proposed.
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Case reports
A 57-year-old Japanese man developed fever and intermittent abdominal pain for 2 days prior to admission on 30 June, 1999. He vomited once on arrival at our emergency service, and soon developed intermittent muscular twitches at left face that became generalized tonic clonic seizures and subsequent status epilepticus. On arrival, the vital signs were as follows: body temperature was 38.2°C, blood pressure measured 160 mmHg systolic and 90 mmHg diastolic. Pulse rate was 96 beats per min and
Discussion
Depression of regional neuronal activity, regional brain perfusion and metabolism remote from the diseased cortical area is called diaschisis [1], [2], [3]. It is common in the clinical setting of cerebral hemispheric ischemic strokes, but is extremely rare in viral encephalitis. Transcallosal diaschisis has been described in a patient with Koshevnikov syndrome and pathologically verified chronic viral encephalitis [4]. Depression of the excitatory transcallosal connecting fiber [5] or delayed
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