The Cerebellum

, Volume 12, Issue 5, pp 686–691 | Cite as

Posterior Fossa Syndrome After Cerebellar Stroke

  • Peter Mariën
  • Lieven Verslegers
  • Maarten Moens
  • Guido Dua
  • Piet Herregods
  • Jo Verhoeven
Original Paper


Posterior fossa syndrome (PFS) due to vascular etiology is rare in children and adults. To the best of our knowledge, PFS due to cerebellar stroke has only been reported in patients who also underwent surgical treatment of the underlying vascular cause. We report longitudinal clinical, neurocognitive and neuroradiological findings in a 71-year-old right-handed patient who developed PFS following a right cerebellar haemorrhage that was not surgically evacuated. During follow-up, functional neuroimaging was conducted by means of quantified Tc-99m-ECD SPECT studies. After a 10-day period of akinetic mutism, the clinical picture developed into cerebellar cognitive affective syndrome (CCAS) with reversion to a previously learnt accent, consistent with neurogenic foreign accent syndrome (FAS). No psychometric evidence for dementia was found. Quantified Tc-99m-ECD SPECT studies consistently disclosed perfusional deficits in the anatomoclinically suspected but structurally intact bilateral prefrontal brain regions. Since no surgical treatment of the cerebellar haematoma was performed, this case report is presumably the first description of pure, “non-surgical vascular PFS”. In addition, reversion to a previously learnt accent which represents a subtype of FAS has never been reported after cerebellar damage. The combination of this unique constellation of poststroke neurobehavioural changes reflected on SPECT shows that the cerebellum is crucially implicated in the modulation of neurocognitive and affective processes. A decrease of excitatory impulses from the lesioned cerebellum to the structurally intact supratentorial network subserving cognitive, behavioural and affective processes constitutes the likely pathophysiological mechanism underlying PFS and CCAS in this patient.


Posterior fossa syndrome Cerebellar cognitive affective syndrome Foreign accent syndrome Stroke SPECT Cerebellum 


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Peter Mariën
    • 1
    • 6
    • 7
    • 8
  • Lieven Verslegers
    • 1
  • Maarten Moens
    • 4
  • Guido Dua
    • 2
  • Piet Herregods
    • 3
  • Jo Verhoeven
    • 5
    • 7
  1. 1.Department of Neurology and Memory ClinicZNA Middelheim General HospitalAntwerpBelgium
  2. 2.Department of NeurosurgeryZNA Middelheim General HospitalAntwerpBelgium
  3. 3.Department of NeurorehabilitationZNA Middelheim General HospitalAntwerpBelgium
  4. 4.Department of NeurosurgeryUZ BrusselBrusselsBelgium
  5. 5.Department of Language and Communication ScienceCity University LondonLondonUK
  6. 6.Department of Clinical and Experimental NeurolinguisticsVrije Universiteit BrusselBrusselsBelgium
  7. 7.VLAC (Vlaams Academisch Centrum); Advanced Studies Institute of the Royal Flemish Academy of Belgium for Sciences and the ArtsBrusselsBelgium
  8. 8.Department of Neurology and Memory ClinicZNA MiddelheimAntwerpBelgium

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