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Delayed-Onset Cerebellar Syndrome
Elan D. Louis, MD, MS;
Timothy Lynch, MRCPI;
Blair Ford, MD, MRCP;
Paul Greene, MD;
Susan B. Bressman, MD;
Stanley Fahn, MD
Arch Neurol. 1996;53(5):450-454.
Abstract
Background
Delayed-onset involuntary movements, including dystonia and myoclonus, have been reported after stroke or head trauma. Moreover, there have been reports of delayed-onset isolated intention tremor and, in several of these cases, gait ataxia.
Objective
To further define the clinical features of a delayed-onset cerebellar syndrome.
Design
Subjects with cerebellar tremor and either head trauma or stroke were identified using a computerized database, providing detailed demographic and clinical information on 4002 patients with involuntary movements other than Parkinson's disease seen at our center between 1983 and 1995. Medical records and videotaped neurological examinations were retrospectively reviewed.
Setting
The Center for Parkinson's Disease and Other Movement Disorders at Columbia-Presbyterian Medical Center, New York, NY.
Patients
Five patients with delayed-onset cerebellar syndromes.
Results
Five patients with stroke or head trauma developed a cerebellar syndrome 3 weeks to 2 years after the initial insult. The syndrome, characterized by intention tremor, ataxic dysarthria, nystagmus, dysmetria, dysdiadochokinesis, and gait ataxia, was progressive in at least one patient. In four patients, lesions were present on neuroimaging in the thalamus or brain stem (especially in the midbrain).
Conclusions
A delayed-onset cerebellar syndrome may follow head trauma or stroke. The syndrome is sometimes progressive and often disabling. The delayed onset implies that the syndrome is not caused by the initial lesion itself but may be caused by the development of post-synaptic supersensitivity or secondary reorganization of involved pathways.
Author Affiliations
From the Department of Neurology (Drs Louis, Lynch, Ford, Greene, Bressman, and Fahn) and the Gertrude H. Sergievsky Center (Dr Louis), Columbia University College of Physicians and Surgeons, New York, NY.
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