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Título

The Cerebellar Cognitive Affective Syndrome as manifestation of ischemic stroke: Case Report.

RESUMO

The cerebellum is the control center for voluntary movements and coordination contributing to planning, execution and modulation of movements. However, research reveals a wider role of the cerebellum in cognitive, emotional, and behavioral functions because of widespread cerebellar connections to the cortex and associated areas. Clinically, Cerebellar Cognitive Affective Syndrome (CACS), also known as Schmahmann's Syndrome, is characterized by language deficits, visual and spatial executive functions, and personality changes seen in patients with focal cerebellar lesions. Some studies with maps of lesions with clinical diagnosis in patients with CACS and normal motor performance suggest the posterior cerebellar injury involving the lobes VII and VIII, being a risk factor for cognitive deficits. We report the case of a male patient, 82 years old, admitted to a semi-intensive therapy presenting with a delta time greater than 5 hours with speech impaired and understanding, inappropriate laughter and presence of logorrhea in the eyes of his relatives (wife and son). Patient referred for hospitalization to the care of neurology as a diagnostic hypothesis of Cerebral Vascular Accident. Neurological physical exams show a conscious and cooperative elderly man with cautious gait, reduced grammatical speech, lack of fluency and inadequate understanding and laughter; tests for coordination (nose finger test, heel test and dysdiadochokinesia) were normal, sensory and motor systems within normality, cranial nerves without alterations. Mental functions reveal impaired attention and concentration, recent memory, and altered perception. MRI Brain showed a peripheral intraparenchymal focus in the right cerebellar hemisphere presenting restriction to the diffusion of water in the Ecoplanar sequence, with a weak hypersignal in the T2 / FLAIR sequence. After extensive diagnostic and exclusionary investigation, the diagnosis of Cerebellar Vascular Accident with cognitive manifestation and without motor impairment was instituted. The Cerebellar Cognitive Affective Syndrome conceptualized by Schmahmann and Sherman, seen in a patient with cerebellar damage, was clinically prominent in patients with cerebellar posterior lobe disease and worms, and there may be several causes of cerebellar damage, such as viral infections and drugs, but no specific etiology can be detected in our patient, which evidenced cause of ischemic vascular etiology of cerebellar damage.