Visual Neglect after PICA Stroke-A Case Study

After cerebellar stroke, cognition can be impaired, as described within the framework of the so-called Cerebellar Cognitive Affective Syndrome (CCAS). However, it remains unclear whether visual neglect can also be part of CCAS. We describe the case of a patient with a subacute cerebellar stroke after thrombosis of the left posterior inferior cerebellar artery (PICA), who showed a left-sided visual neglect, indicating that the cerebellum also has a modulatory function on visual attention. The neglect, however, was mild and only detectable when using the sensitive neuro-psychological Five-Point Test as well as video-oculography assessment, yet remained unnoticed when evaluated with common neglect-specific paper-pencil tests. Three weeks later, follow-up assessments revealed an amelioration of neglect symptoms. Therefore, these findings suggest that visual neglect may be a part of CCAS, but that the choice of neglect assessments and the time delay since stroke onset may be crucial. Although the exact underlying pathophysiological mechanisms remain unclear, we propose cerebellar-cerebral diaschisis as a possible explanation of why neglect can occur on the ipsilateral side. Further research applying sensitive assessment tools at different post-stroke stages is needed to investigate the incidence, lesion correlates, and pathophysiology of neglect after cerebellar lesions.

Automated summary

Cognitive impairment is common after cerebellar stroke, known as Cerebellar Cognitive Affective Syndrome (CCAS). This study presents a case of a patient with subacute cerebellar stroke and left-sided visual neglect, suggesting that the cerebellum also modulates visual attention. However, the neglect was only detected using sensitive neuro-psychological tests and video-oculography assessment, while traditional paper-pencil neglect tests failed to detect it. Follow-up assessments after three weeks showed an improvement in neglect symptoms. These findings suggest that visual neglect may be part of CCAS, but the choice of assessment tools and time delay since stroke onset play a crucial role.