Cognitive impairment and affective disorder: A rare presentation of cerebellar stroke

Abstract

The awareness of the "Cerebellar Cognitive Affective Syndrome" (CCAS) as a clinical entity is emerging. The CCAS is characterized by impaired executive functions, linguistic skills, visuospatial cognition and personality change. Here we report a 56-year-old, male teacher who developed acute psychomotor retardation, low energy level, infrequent speech, and mild cognitive decline. Two months before admission, he was initially diagnosed as depression, and later misdiagnosed as encephalitis, which misled him to receive high-dose intravenous steroids and antimicrobial drugs. The Brain MRI revealed multiple posterior cerebellar infarcts predominantly at the lobules VII and VIII. The standard neuropsychological tests were unremarkable; however, the CCAS Scale confirmed the diagnosis. The treatment of depression and secondary prevention of stroke was conducted. In cases that present with features of cognitive and affective disorders but with mild voluntary motor or without typical cerebellar features, the role of posterior cerebellar and vermian pathologies should be considered. The CCAS Scale is an appropriate screening tool to detect these patients and provides a framework for evidence-based treatment.

Keywords: CCAS scale; Cerebellum; Depression; Infarct; Schmahmann syndrome.