Cerebellar cognitive affective syndrome (CCAS) is characterized by alterations at the cognitive level (dysexecutive syndrome, visuospatial deficit, language ...), associated with affective / emotional changes. Its pathophysiology is not well known and there is currently no specific treatment. We describe a 64-year-old man with a rare condition of cognitive-behavioral disorder after an infarction in the left middle cerebral artery, dominated by executive dysfunctions, predominantly oral apraxia, interrupted divided attention, disturbed visuospatial organization and affective abnormalities with great apathy, and whose symptoms improved with a selective serotonin reuptake inhibitor (SSRI). In absence of cerebellar structural damage, a perfusion brain single photon emission computed tomography using 99mTc- hexamethyl-propylene-aminoxime (SPECT-HMPAO) showed left frontotemporal and parietoccipital hypoperfusion of known vascular etiology, and hypoperfusion in the right cerebellar hemisphere compatible with the phenomenon of crossed diaschisis. We hypothesize that cognitive and affective deficits are aggravated by the functional disruption of the reciprocal cerebellar interconnections with areas of cerebral association and paralimbic cortex, altering the contribution of the cerebellum to cognitive and affective processing and modulation. In the case described, both the clinical situation and the functional control images improved after treatment with SSRI, which increases the possibility that there is connectivity of some serotonergic transmission projections between cerebellum and contralateral association cortices, and that said connectivity dysfunctional is involved in the pathophysiology of CCAS.
Keywords: Cerebellar cognitive affective syndrome; stroke; SPECT; cross hemispheric diaschisis; selective serotonin reuptake inhibitor.