Crossed cerebellar diaschisis in a patient with Dyke-Davidoff-Masson syndrome
Presentation
Right hemiplegia since childhood with left hemiparesis.
Patient Data
The MRI sequences demonstrate:
atrophy of the left cerebral hemisphere with cystic encephalomalacia, surrounding gliosis and ex-vacuo dilatation of the ipsilateral lateral ventricle
ipsilateral falcine displacement
compensatory thickening of the ipsilateral skull vault
enlargement of the ipsilateral frontal sinus and mastoid air cells
volume loss to the contralateral cerebellar hemisphere with gliosis, known as crossed cerebellar atrophy
Case Discussion
MRI features of right cerebellar atrophy are most likely due to crossed cerebellar diaschisis secondary to contralateral left supratentorial cerebral infarction in childhood (Dyke-Davidoff-Masson syndrome).
Crossed cerebellar diaschisis refers to a depression in function, metabolism, and perfusion affecting a cerebellar hemisphere occurring as a result of a contralateral focal supratentorial lesion (usually an infarct). The mechanism is thought to be an interruption of cortico-ponto-cerebellar white matter tracts, which then results in differentiation and hypometabolism of the contralateral cerebellar hemisphere.
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