The purpose of our study was to evaluate the remote effects on the cerebell
um and cerebral cortex from subcortical hematoma without cortical structura
l abnormality. Methods: Our study included 23 patients with hematoma, stric
tly confined either to the basal ganglia (n = 12) or thalamus (n = II) with
out cortical abnormality on CT or MRI. Twenty psychiatric patients without
structural abnormality on MRI were selected as control subjects. Technetium
-ethyl cysteinate dimer brain SPECT was performed in patients and control s
ubjects. Regional cerebral blood flow (rCBF) was visually and semiquantitat
ively assessed. Asymmetry index (AI) was determined using data from regions
of interest at the basal ganglia, thalamus, cerebellum, frontal, parietal
and temporal cortex to support the semiquantitative analysis. The criteria
for defining hypoperfusion that reflected diaschisis was based on an Al > t
he mean + 2 s.d. of Al in control subjects. Results: In the basal ganglia h
ematoma, rCBF was reduced significantly in the contralateral cerebellum (10
/12), ipsilateral thalamus (12/12), ipsilateral frontal (6/12), parietal (1
2/12) and temporal cortex (10/12). As for thalamic hematoma, significantly
reduced perfusion was seen in the contralateral cerebellum (10/11), ipsilat
eral basal ganglia (7/11), ipsilateral frontal (5/11), parietal (11/11) and
temporal cortex (3/11). Conclusion: Crossed cerebellar diaschisis (CCD) an
d cortical diaschisis frequently were observed in patients with subcortical
hematoma without cortical structural abnormality. This suggested that CCD
can develop regardless of interruption of the corticopontocerebellar tract,
which is the principal pathway of CCD.