ABSTRACT: Objective: The seminal paper on cerebellar cognitive affective syndrome by Schmahmann and Sherman (1998), and subsequent studies, has expanded our understanding of the role of the cerebellum beyond motor functioning to psychological and cognitive functioning. However, many of these studies have examined patients between 1 week and 5 years post-injury and have tended to exclude patients with prior neurological injuries. Thus, the objective of this case study was to examine cerebellar injury in the context of remote traumatic brain injury (TBI) and describe the long-term cognitive, psychological, and psychosocial sequelae of injury in a 33-year-old, right-handed, Caucasian veteran (S.M.). Method: At age 23, S.M. was referred for neuroimaging by psychiatry due to concern that a TBI from age 16 was the cause of recent onset aggressive behavior. Multiple neuroimaging studies showed no neuroanatomical sequelae of TBI, but revealed a right cerebellar arteriovenous malformation (AVM). Embolization resulted in >50% removal of the AVM, but uncovered an intranidal aneurysm. Repeat neuroimaging revealed a large hemorrhage within the cerebellum with the mass effect and hydrocephalus; subsequent treatment resulted in a complicated 5-month hospital stay. Results: Neuropsychological evaluation conducted 10 years after injury revealed deficits in basic attention, working memory, and information processing speed with relatively intact executive functioning and memory. Physical deficits, including ataxia, dysarthria, and spasticity, and psychological difficulties, including impulsivity and low frustration tolerance, were more prominent and caused significant psychosocial distress, impacting interpersonal relationships. Conclusions: This case highlights the cognitive residual of cerebellar injury and the potential long-term impact on psychological and social functioning.
Archives of Clinical Neuropsychology 09/2011; 26(6):470-567. · 2.18 Impact Factor