Crossed cerebellar diaschisis in herpes simplex encephalitis

https://doi.org/10.1016/S0720-048X(00)00293-XGet rights and content

Abstract

Diaschisis is extremely rare in patients with viral encephalitis. We report the phenomenon of crossed cerebellar diaschisis (CCD) in a 73-year-old man with acute herpes simplex type-1 (HSV-1) encephalitis. The diagnosis of HSV-1 encephalitis was confirmed by detecting HSV-1 deoxyribonucleic acid in the cerebrospinal fluid (CSF). Magnetic resonance images (MRI) showed enhancing lesions at bilateral temporal lobes, insular cortices, and right frontoparietal lobes. Increase signal intensity on T2-weighted images was seen in the mesecephalon. Technetium-99m ethyl cysteinate dimer (99mTc-ECD) single photon emission computed tomography (SPECT) of the brain showed a large area of hypoperfusion in the right frontotemporoparietal lobes. The side-to-side cerebellar count revealed 19% reduction of the radioisotope tracer uptake in the left cerebellum. The phenomenon of CCD was proposed to be due to both anterograde disconnection of the corticopontocerebellar tracts and retrograde deafferentation of dentatothalamocortical projections.

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.

Section snippets

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

References (17)

  • F. Conti et al.

    The neurotransmitters and postsynaptic actions of callosally projecting neurons

    Behav. Brain Res.

    (1994)
  • C. Von Monakow
  • W.H. Kempinsky

    Experimental study of distant effects of acute focal brain injury

    Arch. Neurol. Psychiatry

    (1958)
  • J.C. Baron et al.

    ‘Crossed cerebellar diaschisis’ in human supratentorial brain infarction

    Trans. Am. Neurol. Assoc.

    (1980)
  • P. Thajeb et al.

    Diaschisis in chronic viral encephalitis with Koshevnikov syndrome

    J. Neuroimaging

    (1999)
  • S. Iglesias et al.

    Do changes in oxygen metabolism in the unaffected cerebral hemisphere underlie early neurological recovery after stroke? A positron emission tomography study

    Stroke

    (1996)
  • C.H. Park et al.

    Reverse crossed cerebellar diaschisis in partial complex seizures related to herpes simplex encephalitis

    Clin. Nucl. Med.

    (1992)
  • J.M. Mountz et al.

    Regional cerebral blood flow changes in stroke imaged by Tc-99m HMPAO SPECT with corresponding anatomic image comparison

    Clin. Nucl. Med.

    (1993)
There are more references available in the full text version of this article.

Cited by (0)

View full text