Postural asymmetry correlated with lateralization of cerebellar perfusion in persons with chronic stroke: A role of crossed cerebellar diaschisis in left side

Abstract

Objective: Hemiplegia after stroke leads to impairment of the affected limbs and induces more weight on the non-paretic lower limb to form postural asymmetry. Studies of asymmetric cerebral functions have found similarly asymmetric functions in the cerebellum. Crossed cerebellar diaschisis (CCD) is defined as reduced blood flow and hypometabolism in the cerebellar hemisphere contralateral to supratentorial cerebral pathology. No study explored the relationship between posture (standing balance) and CCD in those persons yet. It was hypothesized that CCD would impair postural control and tend toward lateralization of cerebellar perfusion.

Methods: To determine the relationship between postural asymmetry and CCD among patients with chronic stroke while testing in the upright position. Based on images from Tc-99m-ECD brain perfusion, 42 patients were retrospectively allocated into three groups: left CCD, right CCD and no CCD. The ability to maintain an upright stance as assessed by postural parameters was evaluated using a force platform.

Results: The sway intensity differed significantly between the groups with left CCD and no CCD (p = 0.0052), as did the sway velocities (p = 0.0010). The association between the duration of stroke and sway intensity was highly significant (p < 0.0001). The interval from the stroke onset to the postural analysis was significantly associated with sway intensity and velocity.

Conclusions: This study indicates that the impairment of posture sway control was more severe in left CCD than the other CCD types. The results support a relationship between the postural asymmetry and lateralization of CCD in patients with chronic stroke.

Keywords:

• Hemiplegic stroke
• crossed cerebellar diaschisis
• perfusion lateralization
• postural sway
• postural imbalance
• single-photon emission computed tomography

Acknowledgements

The authors would like to thank their host institutions for the opportunity to pursue this research and the reviewers of this paper for the invaluable comments.

Declaration of interest

The authors report no conflicts of interest. This research project was supported by Scientific Research Grant provided by the Ministry of National Defense-Medical Affairs Bureau (No. 103-M064), and the National Science Council, Executive Yuan (No. NSC 102-2314-B-075A-016).