 |
|
Crossed Cerebellar Atrophy in Patients With Precocious Destructive Brain Insults
Ricardo A. Teixeira, MD;
Li M. Li, MD, PhD;
Sergio L. M. Santos, MD;
Veronica A. Zanardi, MD, PhD;
Carlos A. M. Guerreiro, MD, PhD;
Fernando Cendes, MD, PhD
Arch Neurol. 2002;59:843-847.
Objective To analyze the frequency and pathogenetic factors of crossed cerebellar
atrophy (CCA) in adult patients with epilepsy secondary to destructive brain
insults of early development.
Methods We studied 51 adult patients with epilepsy and precocious destructive
lesions. Patients were divided into 3 groups according to the topographic
distribution of their lesions on magnetic resonance imaging: group A, hemispheric
(n = 9); group B, main arterial territory (n = 25); and group C, arterial
border zone (n = 17). We evaluated the presence of CCA visually and with cerebellar
volumetric measurement, correlating it with the clinical data. Other features
shown on magnetic resonance imaging, such as the thalamus, brainstem, and
middle cerebellar peduncle, were also carefully analyzed.
Results Seven patients (13%) had CCA that was associated with the extent of
the supratentorial lesion (6 from group A, 1 from group B, and none from group
C; P<.001). Status epilepticus was present in
6 patients from group A and in none from the other groups. There was an association
between the antecedent of status epilepticus and CCA (P<.001). All patients had atrophy of the cerebral peduncle ipsilateral
to the supratentorial lesion and 4 had contralateral atrophy of the middle
cerebellar peduncle. The duration of epilepsy was not associated with the
presence of CCA (P = .20).
Conclusions Our data suggest that in patients with epilepsy and destructive insults
early in life, the extent of the supratentorial lesion as well as the antecedent
of status epilepticus play a major role in the pathogenesis of CCA. Recurrent
seizures do not seem to be relevant to the development of CCA.
From the Departments of Neurology (Drs Teixeira, Li, Guerreiro, and
Cendes) and Radiology (Drs Santos and Zanardi), University of Campinas, Campinas,
Brazil.
RELATED ARTICLE
Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 2002;59(5):878-880.
FULL TEXT
|
