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Left Cerebellar Lesions may be Associated with an Increase in Spatial Neglect-like Symptoms

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Abstract

Each cerebellar hemisphere projects to the contralateral cerebral hemisphere. Previous research suggests a lateralization of cognitive functions in the cerebellum that mirrors the cerebral cortex, with attention/visuospatial functions represented in the left cerebellar hemisphere, and language functions in the right cerebellar hemisphere. Although there is good evidence supporting the role of the right cerebellum with language functions, the evidence supporting the notion that attention and visuospatial functions are left lateralized is less clear. Given that spatial neglect is one of the most common disorders arising from right cortical damage, we reasoned that damage to the left cerebellum would result in increased spatial neglect-like symptoms, without necessarily leading to an official diagnosis of spatial neglect. To examine this disconnection hypothesis, we analyzed neglect screening data (line bisection, cancellation, figure copying) from 20 patients with isolated unilateral cerebellar stroke. Results indicated that left cerebellar patients (n = 9) missed significantly more targets on the left side of cancellation tasks compared to a normative sample. No significant effects were observed for right cerebellar patients (n = 11). A lesion overlap analysis indicated that Crus II (78% overlap), and lobules VII and IX (66% overlap) were the regions most commonly damaged in left cerebellar patients. Our results are consistent with the notion that the left cerebellum may be important for attention and visuospatial functions. Given the poor prognosis typically associated with neglect, we suggest that screening for neglect symptoms, and visuospatial deficits more generally, may be important for tailoring rehabilitative efforts to help maximize recovery in cerebellar patients.

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Data Availability

The authors confirm that the summarized group data supporting the findings of this study are available within the article and its Supplementary Material. Raw data and individual participant data cannot be made available because of ethical restrictions. Specifically, all participants in the study signed a consent form which indicated that only the researchers involved in the study would have access to individual participant data. Requests for access to individual participant data must be submitted to the corresponding author, and data sharing agreements must be submitted to the University of Waterloo Office of Research Ethics and the University of Calgary Conjoint Health Research Ethics Board.

Materials Availability

The materials used in this study can either by easily be recreated from the descriptions provided in the Methods section (e.g., line bisection) or are copyrighted and cannot be freely shared (i.e., the line bisection, star cancellation and figure copying subtests of the Behavioural Inattention Test; Bells cancellation).

Notes

  1. Note that previous studies have indicated that line bisection errors in patients with neglect do not increase in a strictly linear fashion with increases in line length [62]. Given that this was a retrospective analysis of neglect screening data from two different sites using different line lengths, calculating percent deviation from center was our best option to attempt to control for differences in line length.

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Acknowledgements

The authors would like to thank Adam Morrill for his assistance with processing the neglect screening data, and Matt Chilvers for his assistance with processing the lesion data.

Funding

This work was supported by a Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant (2022–03608) and a MacEwan University Strategic Research Grant (02110) to Christopher Striemer, an NSERC Discovery Grant (50503–10762) to James Danckert, and a Canadian Institutes of Health Research (CIHR) Operating Grant (MOP 106662) and a Heart and Stroke Foundation of Canada Grant in Aid (G-13–0003029) to Sean Dukelow.

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Authors and Affiliations

  1. Department of Psychology, MacEwan University, Edmonton, AB, Canada

    Ryan Verbitsky & Christopher L. Striemer

  2. Department of Psychology, University of Waterloo, Waterloo, ON, Canada

    Britt Anderson & James Danckert

  3. Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

    Sean Dukelow

  4. Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada

    Christopher L. Striemer

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Contributions

Conceptualization and study design: Christopher Striemer. Data collection: James Danckert and Sean Dukelow. Data analysis: Ryan Verbitsky and Christopher Striemer. Lesion tracing: Britt Anderson. The first draft of the manuscript was written by Ryan Verbitsky and Christopher Striemer. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Christopher L. Striemer.

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Verbitsky, R., Anderson, B., Danckert, J. et al. Left Cerebellar Lesions may be Associated with an Increase in Spatial Neglect-like Symptoms. Cerebellum 23, 431–443 (2024). https://doi.org/10.1007/s12311-023-01542-4

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