Crossed cerebellar diaschisis in status epilepticus.
BACKGROUND
Crossed cerebellar diaschisis (CCD) has been reported on positron-emission tomography and single-photon emission computed tomography of stroke patients. Rarely it has been described with brain diffusion-weighted MRI (DWI) of status epilepticus (SE).


METHODS
Case report.


RESULTS
A 53-year-old woman was found unresponsive after cocaine use. A diagnostic electroencephalogram was consistent with ictal SE. A brain DWI showed reduced diffusion in the left temporo-parietal and occipital cortexes, the left thalamus and the right cerebellum. The DWI changes did not correspond to a vascular territory and were attributed to seizure activity and secondary CCD. A 2-week follow-up DWI showed interval near-complete resolution of the diffusion changes. CCD in SE may represent injury caused by excessive neuronal transmission from prolonged excitatory synaptic activity via the cortico-pontine-cerebellar pathway. Alternatively, it may be a result of interruption of the cortico-pontine-cerebellar pathway with loss of cortical inhibitory input.


CONCLUSIONS
This case documents CCD during SE, providing further evidence of contralateral cerebellar involvement with a supratentorial epileptiform focus.
Samaniego
Edgar A
EA
Stanford University, 701 Welch Road, Suite B 325, Palo Alto, CA 94304, USA. esamanie@stanford.edu
Stuckert
Erika
E
Fischbein
Nancy
N
Wijman
Christine A C
CA
D002545:Brain Ischemia / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D002526:Cerebellar Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000503:physiopathology; D002531:Cerebellum / Q000098:blood supply*; D019970:Cocaine-Related Disorders / Q000175:diagnosis* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000187:drug effects / Q000502:physiology*; D004569:Electroencephalography; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009474:Neurons / Q000187:drug effects / Q000502:physiology; D013226:Status Epilepticus / Q000139:chemically induced* / Q000175:diagnosis* / Q000503:physiopathology