Longitudinal changes in the inferior cerebellar peduncle and lower limb motor recovery following subcortical infarction

Background The cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements. However, the longitudinal changes in the spinocerebellar pathway in the early stage of unilateral supratentorial stroke and their potential clinical significance have received little attention. Methods Diffusion tensor imaging and Fugl-Meyer assessment of lower limb were performed 1, 4, and 12 weeks after onset in 33 patients with acute subcortical infarction involving the supratentorial areas, and in 33 healthy subjects. We evaluated group differences in diffusion metrics in the bilateral inferior cerebellar peduncle (ICP) and analyzed the correlation between ICP diffusion metrics and changes to the Fugl-Meyer scores of the affected lower limb within 12 weeks after stroke. Results Significantly decreased fractional anisotropy and increased mean diffusivity were found in the contralesional ICP at week 12 after stroke compared to controls (all P < 0.01) and those at week 1 (all P < 0.05). There were significant fractional anisotropy decreases in the ipsilesional ICP at week 4 (P = 0.008) and week 12 (P = 0.004) compared to controls. Both fractional anisotropy (rs = 0.416, P = 0.025) and mean diffusivity (rs = -0.507, P = 0.005) changes in the contralesional ICP correlated with changes in Fugl-Meyer scores of the affected lower limb in all patients. Conclusions Bilateral ICP degeneration occurs in the early phase of supratentorial stroke, and diffusion metric values of the contralesional ICP are useful indicators of affected lower limb function after supratentorial stroke.

Longitudinal changes in the inferior cerebellar peduncle and lower limb motor recovery following subcortical infarction

BackgroundThe cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements. However, the longitudinal changes in the spinocerebellar pathway in the early stage of unilateral supratentorial stroke and their potential clinical significance have received little attention. MethodsDiffusion tensor imaging and Fugl-Meyer assessment of lower limb were performed 1, 4, and 12 weeks after onset in 33 patients with acute subcortical infarction involving the supratentorial areas, and in 33 normal subjects. We evaluated group differences in diffusion metrics in the bilateral inferior cerebellar peduncle (ICP) and analyzed the correlation between ICP diffusion metrics and changes to the Fugl-Meyer scores of the affected lower limb within 12 weeks after stroke. ResultsSignificantly decreased fractional anisotropy and increased mean diffusivity were found in the contralesional ICP at week 12 post stroke relative to controls (all P < 0.01) and those at week 1 (all P < 0.05). There were significant fractional anisotropy decreases in the ipsilesional ICP at week 4 (P = 0.008) and week 12 (P = 0.004) relative to controls. Both fractional anisotropy (rs = 0.374, P = 0.038) and mean diffusivity (rs = -0.499, P = 0.004) changes in the contralesional ICP correlated with changes in Fugl-Meyer scores of the affected lower limbs in all patients.ConclusionBilateral ICP degeneration occur in the early phase of supratentorial stroke and contralesional ICP degeneration may hinder recovery of the affected lower limb. ICP could serve as a potential therapeutic target for improving lower limb function after supratentorial stroke.

Microsurgical resection of an inferior cerebellar peduncle cavernous malformation: 3-Dimensional operative video

Brainstem cavernous malformations are especially difficult to treat because of their deep location and intimate relation with eloquent structures. This is the case of a 26-year-old female presenting with dizziness, dysmetria, nystagmus and unbalance. Imaging depicted a lesion highly suggestive of a cavernous malformation in the left inferior cerebellar peduncle. Following a suboccipital midline craniotomy, the cerebellomedullary fissure was dissected and the lesion was identified bulging the surface. The malformation was completely removed with constant intraoperative neurophysiological monitoring. The patient presented improvement of initial symptoms with no new deficits. Surgical resection of brainstem cavernous malformations can be successfully performed, especially when superficial, using the inferior cerebellar peduncle as an entry zone.The video can be found here: https://youtu.be/-GGZe_CaZnQ.

Study of Diameter of Inferior Cerebellar Peduncle in Bangladeshi Cadaver

Background: The cerebellum is a very important part of central nervous system. It is involved in the maintenance of balance and posture, coordination of voluntary movements, motor learning and cognitive functions such as language. Inferior cerebellar peduncle connects the spinal cord and medulla oblongata with the cerebellum and carries unconsciousness proprioceptive information from body and limb. The mean diameter of inferior cerebellar peduncle at birth is only a fraction of the adult diameter then diameter increases up to certain age and decreases in old age.Objectives: The present study was done to observe the diameter of the inferior cerebellar peduncle in different age groups of Bangladeshi cadaver which will serve as a baseline data for clinician about the neurological disorders in our country.Materials and Methods: A cross sectional, analytical type of study was carried out in the department of anatomy, Mymensingh Medical College, Mymensingh from April'2009 to September'2009. A total of 63 cerebellums were collected of which 40 (male 25 and female 15) were from during postmortem of unclaimed Bangladeshi cadaver aged between 5 to 60 years and 23 (male 14 and female 9) were from caesarian section of dead fetuses aged between 34 wks to 42 wks. of gestation. The collected sample was grouped into three age groups like Group A (34 to 42 weeks of gestation), Group B (5 to 30 years) and Group C (31 to 60 years). The diameters of the inferior cerebellar peduncles were measured by using slide calipers and expressed in millimeter (mm).Result: The mean (±SD) diameter of right inferior cerebellar peduncle was in Group A 5.40±1.13, B 7.72±1.18 and C 6.77±1.68 mm respectively and the mean (±SD) diameter of left inferior cerebellar peduncle was in Group A 5.20±1.09, B 7.59±1.23 and C 6.66±1.58 mm respectively.Conclusion: From the present study it is observed that the mean diameter of the inferior cerebellar peduncle increased with age upto certain level then slightly decreased in the late age. The result of the present study will enrich the information pool on diameter of the inferior cerebellar peduncle of Bangladeshi people.KYAMC Journal Vol. 8, No.-1, Jul 2017, Page 27-32