Crossed cerebellar hyperperfusion (CCH) is detected in patients with epilepsy by brain perfusion studies including single photon emission computed tomography and positron emission tomography. In addition, brain perfusion can be studied with arterial spin labeling (ASL), which is a non-invasive MRI perfusion method that quantitatively measures cerebral blood flow per unit tissue mass. We followed up a 47-year-old patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) by continuous arterial spin labeling technique, which showed crossed cerebellar hyperperfusion after acute stroke-like episode. This cerebellar hyperperfusion normalized in the follow-up.
PavlakisSG, PhillipsPC, DiMauroS, Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke like episodes: a distinctive clinical syndrome. Ann Neurol1984;16:481–8
2.
DiMauroS, SchonEA. Mitochondrial respiratory-chain diseases. N Engl J Med2003;348:2656–68
3.
TakahashiS, TohgiH, YonezawaH, Cerebral blood flow and oxygen metabolism before and after a stroke-like episode in patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). J Neurol Sci1998;158:58–64
4.
IizukaT, SakaiF, IdeT, Regional cerebral blood flow and cerebrovascular reactivity during chronic stage of stroke-like episodes in MELAS – implication of neurovascular cellular mechanism. J Neurol Sci2007;257:126–38
5.
TsujikawaT, YonedaM, ShimizuY, Pathophysiologic evaluation of MELAS strokes by serially quantified MRS and CASL perfusion images. Brain Dev2010;32:143–9
6.
WonJH, LeeJD, ChungTS, Increased contralateral cerebellar uptake of technetium-99m-HMPAO on ictal brain SPECT. J Nucl Med1996;37:426–9
7.
HarveyAS, HopkinsIJ, BoweJM, Frontal lobe epilepsy: clinical seizure characteristics and localization with ictal 99mTc-HMPAO SPECT. Neurology1993;43:1966–80
8.
MarksDA, KatzA, HofferP, Localization of extratemporal epileptic foci during ictal single photon emission computed tomography. Ann Neurol1992;31:250–5
9.
ShinWC, HongSB, TaeWS, Ictal hyperperfusion of cerebellum and basal ganglia in temporal lobe epilepsy: SPECT subtraction with MRI coregistration. J Nucl Med2001;42:853–8
10.
DaiW, GarciaD, de BazelaireC, Continuous flow-driven inversion for arterial spin labeling using pulsed radio frequency and gradient fields. Magn Reson Med2008;60:1488–97
11.
FloydTF, RatcliffeSJ, WangJ, Precision of the CASL-perfusion MRI technique for the measurement of cerebral blood flow in whole brain and vascular territories. J Magn Reson Imaging2003;18:649–55
12.
MorrisMF, ZhangY, ZhangH, Features of nephrogenic systemic fibrosis on radiology examinations. Am J Roentgenol2009;193:61–9
