± ± ± ± ± D - CTA 1 1 Mini - mental state examination MMSE Raven s
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1 164 Dementia Japan 25 : , 2011 Mini - mental state examination % Raven s colored progressive matrices % Frontal assessment battery % Shinichiro Maeshima 1, Aiko Osawa 1, Hiroshi Matsuda 2, Yasuhiro Miyazaki 1, Fumitaka Yamane 3, Shoichiro Ishihawa 3, Hiroki Kurita 4, Aikira Satoh 4, Norio Tanahashi Department of Rehabilitation Medicine, 2 Department of Nuclear Medicine, 3 Department of Endovascular Neurosurgery, 4 Department of Cerebrovascular Neurosurgery, 5 Department of Neurology, Saitama Medical University International Medical Center Yamane, Hidaka, Saitama , Japan 10% 2008 Fisher, 1965 Schmahmann et al., 1998 ; 2008 Maeshima et al.,
2 ± ± ± ± ± D - CTA 1 1 Mini - mental state examination MMSE Raven s colored progressive matrices RCPM Frontal assessment battery FAB MMSE 30 Folstein et al., 1975 RCPM 6 36 Raven, 1976 FAB GO - NO - GO Dubois et al., MMSE 23/24 RCPM 24/25 FAB 12/13 CT 1/6 π A B C A, B, C : Single photon emission CT SPECT 99mTc - ECD technetium - 99m L, L - ethyl cysteinate dimer 600 MBq Patlak Plot Matsuda et al., 1995 SPECT 2 SPECT/CT symbia T6 ESOFTP LEHR SPECT 3.3 mm CT PC Matlab Mathworks Statistical Parametric Mapping SPM8, spatial normalization smoothing ANCOVA p<0.05, size in voxels>200 JMP 8.02 χ 2 5% ml 17.7±20.5 ml MMSE % RCPM % FAB % 1
3 166 Dementia Japan Vol. 25 No. 2 September 2011 図 1. 各種認知機能検査と血腫量, 血腫部位の関係 図 2. 各種認知機能検査での異常と関連がみられた局所脳血流の低下部位 2
4 Middleton & Strick, 1998 Sasaki, 1979 Brodmann 46 Middleton & Strick, 1994 Positron emission tomography PET MRI fmri - Crossed cerebellar diaschisis Pantano et al., 1987 ; Brott et al., 1986 ; Baron et al., 1981 ; Pantano et al., 1986 Cerebellocerebral diaschisis Rousseaux & Steinling, 1992 ; Sonmezogle, 1993 ; 1999 Cerebellar cognitive affective syndrome CCAS Schmahmann et al., 1998 Leiner et al., 1986 Mathiak et al., 2002 Gottwald et al., : Baron JC, Bousser MG, Comar D, et al Crossed cerebellar diaschisis ; a remote functional suppression secondary to supratentorial infarction in man. J Cereb Blood Flow Metab 1 : s500 Brott TG, Gelfand MJ, Williams CC, et al Frequency and patterns of abnormality derected by iodine amine emission CT after cerebral infarction. Radiology 158 : Neurol Med Chir 22 : Dubois B, Slachevsky A, Litvan I, et al The FAB : A frontal assessment battery at the bedside. Neurology 55 : Fisher CM, Picard EH, Dalal P, et al Acute hypertensive cerebellar heorrhage : Diagnosis and surgical treatment. J Nerv Ment Dis 140 : Folstein MF, Folstein SE, McHugh PR 1975 Mini - mental
5 168 Dementia Japan Vol. 25 No. 2 September 2011 state : a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 12 : Gottwald B, Wilde B, Mehdorn HM 2004 Evidence for distinct cognitive deficits after focal cerebellar lesions. J Neurol Neurosurg Psychiatry 75 : : Leiner HC, Leiner AL, Dow RS 1986 Does the cerebellum contribute to mental skills? Behav Neurosci 100 : Frontal assessment battery FAB 58 : Maeshima S, Osawa A 2007 Stroke rehabilitation in a patient with cerebellar cognitive affective syndrome. Brain Inj 21 : : Mathiak K, Hertrich I, Grodd W, et al Cerebellum and speech perception : a functional magnetic resonance imaging study. J Cognitive Neurosci 14 : Matsuda H, Yagishita A, Tsuji S, et al A quantitative approach to technetium - 99m ethyl cysteinate dimmer ; A comparison with technetium - 99m hexamethylpropylene amine oxime. Eur J Nuc Med 22 : Middleton FA, Strick PL 1994 Anatomical evidence for cerebellar and basal ganglia involvement in higher cognitive function. Science 266 : Middleton FA, Strick PL 1998 The cerebellum : an overview. Trends Cog Sci 3 : Mini - Mental State 1 : : Pantano P, Baron JC, Samson Y, et al Crossed cerebellar diaschisis : further studies. Brain 109 : Pantano P, Lenzi GL, Guidetti B, et al Crossed cerebellar siaschisis in patients with cerebral ischemia assessed by SPECT and 123I - HIPDM. Eur Neurol 27 : Raven JC 1976 Coloured progressive matrices. Oxford Psychologists Press Ltd, London Rousseaux M, Steinling M 1992 Crossed hemispheric diaschisis in unilateral cerebellar lesions. Stroke 23 4 : : Sasaki K 1979 Cerebro - cerebellar interconnections in cats and monkeys. In : Cerebrocerebellar Interactions Massion J and Sasaki K eds pp , Elsevier, Amsterdam Schmahmann JD, Sherman JC 1998 The cerebellar cognitive affective syndrome. Brain 121 : Sonmezogle K 1993 Reduced contralateral hemispheric flow diaschisis. Acta neurol Scand 87 4 : :
6 169 Cognitive dysfunction in patients with acute cerebellar hemorrhage Shinichiro Maeshima 1, Aiko Osawa 1, Hiroshi Matsuda 2, Yasuhiro Miyazaki 1, Fumitaka Yamane 3, Shoichiro Ishihawa 3, Hiroki Kurita 4, Aikira Satoh 4, Norio Tanahashi 5 1 Department of Rehabilitation Medicine, 2 Department of Nuclear Medicine, 3 Department of Endovascular Neurosurgery, 4 Department of Cerebrovascular Neurosurgery, 5 Department of Neurology, Saitama Medical University International Medical Center Recently, several reports suggest that cerebellar damage is associated with visual cognitive disorder, executive dysfunction, and affective change. Focusing on cognitive impairment in cerebellar hemorrhage, we evaluated the relationship between cognitive function and hematoma volume, foci, and cerebral blood flow. An abnormality was detected in 83.3% with the Mini - mental state examination, in 64.5% with the Raven s colored progressive matrices and 76.5% with the Frontal assessment battery. The presence of cognitive impairment did not correlate with hematoma size, while subjects with cognitive impairment had a decrease in regional cerebral blood flow in the thalamus and frontal temporal lobe. Cognitive impairments associated with cerebellar hemorrhage were not rare. A detailed assessment of cognitive function is therefore necessary also in patients with infratentorial lesions. Address correspondence to Dr. Shinichiro Maeshima, Department of Rehabilitation Medicine, Saitama Medical University International Medical Center Yamane, Hidaka, Saitama , Japan
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