CEREBRAL DIASCHISIS FOLLOWING CEREBELLAR HEMORRHAGE

In 1914, Von Monakow described diaschisis, the recovery of lost cortic al function in regions positionally distant from, but linked by neuron al tracts to, the primary site of cortical damage, Cerebellar diaschis is after cortical insult is detailed in the literature; however, corti cal diaschisis after cerebellar insult remains a rarely reported occur rence. We describe a 36-year-old woman with rupture of a right-sided c erebellar arteriovenous malformation who developed such expected cereb ellar signs as ataxia, dysmetria, and nystagmus. Days later, the patie nt developed profound impulsivity, disinhibition, and psychomotor agit ation. Single photon emission computed tomography (SPECT) showed decre ased perfusion of the bilateral frontal and temporal lobes, consistent with regional loss of neural activity. Eventual clinical improvement corresponded with reperfusion of those regions, identified on follow-u p SPECT. This cave documents cortical diaschisis following cerebellar insult and shows that diaschisis must be considered in patients with c erebral injury manifesting cortical deficits remote from the site of p rimary pathology. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitat ion.