Neuropsychiatric outcomes following strokes involving the cerebellum: a retrospective cohort study

Abstract

Introduction: Given the wide-ranging involvement of cerebellar activity in motor, cognitive, and affective functions, clinical outcomes resulting from cerebellar damage can be hard to predict. Cerebellar vascular accidents are rare, comprising less than 5% of strokes, yet this rare patient population could provide essential information to guide our understanding of cerebellar function.

Methods: To gain insight into which domains are affected following cerebellar damage, we retrospectively examined neuropsychiatric performance following cerebellar vascular accidents in cases registered on a database of patients with focal brain injuries. Neuropsychiatric testing included assessment of cognitive (working memory, language processing, and perceptual reasoning), motor (eye movements and fine motor control), and affective (depression and anxiety) domains.

Results: Results indicate that cerebellar vascular accidents are more common in men and starting in the 5th decade of life, in agreement with previous reports. Additionally, in our group of twenty-six patients, statistically significant performance alterations were not detected at the group level an average of 1.3 years following the vascular accident. Marginal decreases in performance were detected in the word and color sub-scales of the Stroop task, the Rey Auditory Verbal Learning Test, and the Lafayette Grooved Pegboard Test.

Discussion: It is well established that the acute phase of cerebellar vascular accidents can be life-threatening, largely due to brainstem compression. In the chronic phase, our findings indicate that recovery of cognitive, emotional, and affective function is likely. However, a minority of individuals may suffer significant long-term performance impairments in motor coordination, verbal working memory, and/or linguistic processing.

Keywords: Rey auditory verbal learning test (RAVLT); basilar artery; grooved pegboard test; posterior cerebellar artery; stroke; stroop test.

Figure 1

Schematic diagram of cerebellar lobules and arteries. SCA, superior cerebellar artery; AICA, anterior inferior cerebellar artery; and PICA, posterior inferior cerebellar artery.

Figure 2

Overlay of lesions resulting from cerebellar vascular accidents. Maximum lesion overlap (n = 7) occurred in the right Crus II, followed by the left lobule VIIIa and a portion of lobule VIIIb (n = 6).

Figure 3

Performance on neuropsychiatric scales. Scores on neuropsychiatric scales administered to individuals who suffered vascular accidents involving the cerebellum. Marginal effects were detected such that cerebellar vascular damage led to worse performance on the Stroop task (word and color sub-scales), the first trial of the Rey Auditory Verbal Learning Test, and the Grooved Pegboard task. Raw scores have been Z-score transformed, where 0 represents no change from the neuronormative population, a positive score represents better performance and a negative score represents worse performance than the neuronormative population, respectively. Error bars represent standard error of the mean. TMT, trail making test; WAIS, Wechsler adult intelligence scale; RAVLT, Rey auditory verbal learning test; COWAT, controlled oral word association test; CFT, complex figure test; and GPT, grooved pegboard test.

Figure 4

Lesion proportion difference maps for the Grooved Pegboard task (A,B) suggest little overlap in cerebellar regions by impairment classification. Lesion proportion difference map for Stroop—word (C), suggest overlap in the crus I and lobule VII region for individuals who were significantly impaired on this task.