Traumatic Cerebellar Dysfunction

Abstract

It has been said that cerebellar symptoms caused by head injury are rare. The first reason is, injury of the cerebellum is usually fatal due to either combined intracranial hemorrhage or brain stem lesions. The second is, the posterior cranial fossa and cerebellum have specific features in anatomical view point so that the cerebellum rarely suffers from injury by impact.
In 1969, R.C. Cantu reported on 2 cases which showed midline cerebellar symptoms consisting of dysarthria, truncal ataxia and rotatory nystagmus following occipital head trauma. He postulated a new syndrome “The transient traumatic cerebellar dysfunction” for this symptoms.
We present 7 cases of post-traumatic cerebellar symptoms caused by closed head trauma. Summary of 7 cases : 1. Ratio of male and female was 5:2, age distribution was from 9 to 34 years of age; 2. Site of trauma included occipital region in 5 cases, frontal region in 1 case, and unknown in 1 case. Initial loss of consciousness was absent in 5 cases, few minutes in 1 case, and 2 weeks in 1 case; 3. Craniogram: 1 case showed right-frontal linear fracture and others were normal; 4. Cerebellar signs revealed were such as dysmetria, dysdiadochokinesis, horizontal nystagmus and ataxia. Other neurological findings such as pyramidal signs and sensory disturbances were negative; 5. Laboratory findings such as lumbar puncture and other pertinent findings were negative; 6. Clinical course: Cerebellar symptoms improved within few days or few months in 6 cases, whithin one year in 1 case; 7. Same symptoms reccurred twice in 1 case following minor occipital injuries.
The symptoms were maximal immediately after trauma and steadily improved in all cases. The pathophysiology of these symptoms, whether it is due to cerebellar concussion or contusion, is unknown. In one case, traumatic infra-tentorial hematoma was suspected and suboccipital exploratory craniectomy was undertaken. However, neither hematoma nor contusion in the posterior cranial fossa and of the cerebellum, was discovered. The observations presented here and the cases reported by other authors suggest that these symptoms may occur with or without cerebellar hemorrhage and contusion. Because the authors experienced a recurrence of these symptoms in one patient as referred in 7., the authors presume that there must be some other predisposition in manifestation of this symptoms. Recognition of this symptoms is not only important but also helpful in the diagnosis of posterior fossa lesions after head injuries.