Abstract
Limb ataxia of sudden onset is due to a vascular lesion in either the cerebellum or the brainstem (posterior circulation, PC, territory). This sign can involve both the upper and the lower limb (hemiataxia) or only one limb (monoataxia). The topographical correlates of limb ataxia have been studied only in brainstem strokes. Therefore, it is not yet known whether this sign is useful to localize the lesion within the entire cerebellar system, both the cerebellar hemisphere and the cerebellar brainstem pathways. Limb ataxia was semi-quantified according to the International Cooperative Ataxia Rating Scale in 92 consecutive patients with acute PC stroke. Limb ataxia was present in 70 patients. Four topographical patterns based on magnetic resonance imaging findings were identified: picaCH pattern (posterior inferior cerebellar artery infarct); scaCH pattern (superior cerebellar artery infarct); CH/CP pattern (infarct involving both the cerebellum and the brainstem cerebellar pathways); and CP pattern (infarct involving the brainstem cerebellar pathways). Hemiataxia was present in (47/70; 67.1%) and monoataxia in (23/70; 32.9%) of patients. Monoataxia involved the upper limb in (19/70; 27.1%) and the lower limb in (4/70; 5.7%) of patients. Limb ataxia usually localized the lesion ipsilaterally (picaCH, scaCH, CH/CP, and CP patterns involving the medulla and sometimes the pons) (53/70; 75.7%), but it might be due also to contralateral (CP pattern involving the pons or midbrain) (16/70; 22.9%) or bilateral lesions (1/70). Limb ataxia usually localizes the lesion ipsilaterally but the infarct might be sometimes contralateral. The occurrence of monoataxia may suggest that the cerebellar system is somatotopically organized.
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References
Amarenco P. The spectrum of cerebellar infarctions. Neurology. 1991;41:973–9.
Amarenco P, Kase CS, Rosengart A, Pessin MS, Bousser MG, Caplan LR. Very small (border zone) cerebellar infarcts. Distribution, causes, mechanisms and clinical features. Brain. 1993;116:161–86.
Amarenco P, Rosengart A, DeWitt D, Pessin MS, Caplan LR. Anterior inferior cerebellar artery territory infarcts. Arch Neurol. 1993;50:154–61.
Kase CS, Norrving B, Levine SR, Babikian VL, Chodosh EH, Wolf PA, et al. Cerebellar infarction: clinical and anatomic observations in 66 cases. Stroke. 1993;24:76–83.
Martin PJ, Chang HM, Wityk R, Caplan LR. Midbrain infarction: associations and aetiologies in the New England Medical Center Posterior Circulation Registry. J Neurol Neurosurg Psychiatry. 1998;64:392–5.
Kim JS. Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients. Brain. 2003;126:1864–72.
Chaves CJ, Caplan LR, Chung CS, Tapia J, Amarenco P, Teal P, et al. Cerebellar infarcts in the New England Medical Center Posterior Circulation Registry. Neurology. 1994;44:1385–90.
Ye BS, Kim YD, Nam HS, Lee HS, Nam CM, Heo JH. Clinical manifestations of cerebellar infarction according to specific lobular involvement. Cerebellum. 2010;9:571–9.
Bogousslavsky J, Maeder P, Regli F, Meuli R. Pure midbrain infarction: clinical syndromes, MRI, and etiologic patterns. Neurology. 1994;44:2032–40.
Kim JS, Lee JH, Im JH, Lee MC. Syndromes of pontine base infarction. A clinical-radiological correlation study. Stroke. 1995;26:950–5.
Kumral E, Bayülkem G, Evyapan D. Clinical spectrum of pontine infarction. Clinical-MRI correlations. J Neurol. 2002;249:1659–70.
Kim JS, Kim J. Pure midbrain infarction. Clinical, radiologic, and pathophysiologic findings. Neurology. 2005;64:1227–32.
Marx JJ, Iannetti GD, Thömke F, Fitzek S, Galeotti F, Truini A, et al. Topodiagnostic implications of hemiataxia: an MRI-based brainstem mapping analysis. NeuroImage. 2008;39:1625–32.
Deluca C, Moretto G, Di Matteo A, Cappellari M, Basile AM, Bonifati DM, et al. Ataxia in posterior circulation stroke: clinical-MRI correlations. J Neurol Sci. 2011;300(1–2):39–46. doi:10.1016/j.jns.2010.10.005.
Trouillas P, Takayanagi T, Hallett M, Currier RD, Subramony SH, Wessel K, et al. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. The Ataxia Neuropharmacology Committee of the World Federation of Neurology. J Neurol Sci. 1997;145:205–11.
Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20:864–70.
Amarenco P, Hauw J-J. Anatomie des arteres cerebelleuses. Rev Neurol. 1989;145:267–76.
Caplan LR, DeWitt LD, Pessin MS, Gorelick PB, Adelman LS. Lateral thalamic infarcts. Arch Neurol. 1988;45:959–64.
Schmahmann JD, Rosene DL, Pandya DN. Ataxia after pontine stroke: insights from pontocerebellar fibers in monkey. Ann Neurol. 2004;55:585–9.
Broadley SA, Taylor J, Waddy HM, Thompson PD. The clinical and MRI correlate of ischeamia in the ventromedial midbrain: Claude’s syndrome. J Neurol. 2001;248:1087–9.
Seo SW, Heo JH, Lee KY, Shin WC, Chang DI, Kim SM, et al. Localization of Claude’s syndrome. Neurology. 2001;57:2304–7.
Lee H, Cho Y-W. Bilateral cerebellar ataxia as the sole manifestation of a unilateral rostral pontine tegmental infarct. J Neurol Neurosurg Psychiatry. 2003;74:1444–6.
Cerrato P, Lentini A, Colonna R, Bosco G, Destefanis E, Caprioli M, et al. Gait and bilateral limb ataxia as isolated feature of a lower midbrain tegmental infarction. A clinical-MRI study. J Neurol. 2008;255:290–1.
Bassetti C, Bogousslavsky J, Barth A, Regli F. Isolated infarcts of the pons. Neurology. 1996;46:165–75.
Paciaroni M, Caso V, Milia P, Venti M, Silvestrelli G, Palmerini F, et al. Isolated monoparesis following stroke. J Neurol Neurosurg Psychiatry. 2005;76:805–7.
Maeder-Ingvar M, van Melle G, Bogousslavsky J. Pure monoparesis: a particular stroke subgroup? Arch Neurol. 2005;62:1221–4.
Kim JS. Restricted acral sensory syndrome following minor stroke. Further observation with special reference to differential severity of symptoms among individual digits. Stroke. 1994;25:2497–502.
Kim JS, Bae YH. Pure or predominant sensory stroke due to brainstem lesion. Stroke. 1997;28:1761–4.
Kim JS, Koh J-H, Lee JH. Medial medullary infarction with restricted sensory symptoms. Eur Neurol. 1998;39:174–7.
Lee S-H, Kim D-E, Song E-C, Roh J-K. Sensory dermatomal representation in the medial lemniscus. Arch Neurol. 2001;58:649–51.
Gonzalez-Alegre P. Monomelic parkinsonian tremor caused by contralateral substantia nigra stroke. Parkinsonism Relat Disord. 2007;13:182–4.
Ikeda M, Tsukagoshi H. Monochorea caused by a striatal lesion. Eur Neurol. 1991;31:257–8.
Manni E, Petrosini L. A century of cerebellar somatotopy: a debated representation. Nat Rev Neurosci. 2004;5:241–9.
Timmann D, Brandauer B, Hermsdörfer J, Ilg W, Konczak J, Gerwig M, et al. Lesion-symptom mapping of the human cerebellum. Cerebellum. 2008;7:602–6.
Snider R, Eldered E. Cerebro-cerebellar relationships in the monkey. J Neurophysiol. 1951;15:27–40.
Grodd W, Hulsmann E, Lotze M, Wildgruber D, Erb M. Sensorimotor mapping of the human cerebellum: fMRI evidence of somatotopic organization. Hum Brain Mapp. 2001;13:55–73.
Schoch B, Dimitrova A, Gisewski ER, Timmann D. Functional localization in the human cerebellum based on voxelwise statistical analysis: a study of 90 patients. NeuroImage. 2006;30:36–51.
Schmahmann JD, Ko R, MacMore J. The human basis pontis: motor syndromes and topographic organization. Brain. 2004;127(Pt 6):1269–91.
Asanuma C, Thach WR, Jones EG. Anatomical evidence for segregated focal groupings of efferent cells and their terminal ramifications in the cerebellothalamic pathway of the monkey. Brain Res. 1983;286:267–97.
Dimitrova A, de Greiff A, Schoch B, Gerwig M, Frings M, Gizewski ER, et al. Activation of cerebellar nuclei comparing finger, foot and tongue movements as revealed by fMRI. Brain Res Bull. 2006;71:233–41. Epub 2006 Oct 10.
Rijntjes M, Buechel C, Kiebel S, Weiller C. Multiple somatotopic representations in the human cerebellum. Neuroreport. 1999;10:3653–8.
Bushara KO, Wheat JM, Khan A, Mock BJ, Turski PA, Sorenson J, et al. Multiple tactile maps in the human cerebellum. Neuroreport. 2001;12:2483–6.
Takanashi M, Abe K, Yanagihara T, Sakoda S, Tanaka H, Hirabuki N, et al. A functional MRI study of somatotopic representation of somatosensory stimulation in the cerebellum. Neuroradiology. 2003;45:149–52. Epub 2003 Feb 18.
Kapreli E, Athanasopoulos S, Papathanasiou M, Van Hecke P, Keleki D, Peeters R, et al. Lower limb sensorimotor network: issues of somatotopy and overlap. Cortex. 2007;43:219–32.
Blitshteyn S, Rubino FA. Pure sensory stroke as an isolated manifestation of the lateral medullary infarction. J Neuroimaging. 2005;15:82–4.
Shibata K, Otuka K, Niishimura Y, Kondo H, Ikeda N, Iwata M. Isolated limb sensory disturbance accompanied with sudden deafness from vertebral artery dissection: a case report. J Neurol Sci. 2007;263:180–3.
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Basile A, Tavolato B, Bonifati DM, Orrico D, Mesiano T, Morra M, Baracchini C, Giometto R, Meneghetti G, Mazzucco S, Ottina M, Micaglio G, Lochner P, Tonon A, Paladin F, Bonometti MA, De Boni A, Perini F, Turinese E, Burlina A, Freddi N, Polo A, Adami A, Bianconi C, Pizzini F, Beltramello A, Buffone E, Passarin MG, Tomelleri G, Bovi P.
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Deluca, C., Moretto, G., Di Matteo, A. et al. Hemi- and Monoataxia in Cerebellar Hemispheres and Peduncles Stroke Lesions: Topographical Correlations. Cerebellum 11, 917–924 (2012). https://doi.org/10.1007/s12311-012-0362-x
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DOI: https://doi.org/10.1007/s12311-012-0362-x