Schmahmann's syndrome

A little post for cerebellar stroke survivors, what you might not know about the unique aftereffects of this particular kind of stroke. The cerebellum works in mysterious ways, it’s a fairly unexplored region of the brain parts in total, but yet has the upper house in neurone representatives. I wasn’t aware of this until recently, but the cerebellum hemispheres align themselves directly to the corresponding body areas, so the left cerebellum hemisphere communicates with the left side of the body and the right to the right. That’s easy isn’t isn’t it … except … the right cerebellum communicates with the left cerebral hemisphere which in turn communicates to the right side of the body, and the left cerebellar hemisphere communicates with the right cerebral hemisphere which communicates to the left side of the body. Did I say easy? My mistake.

What I would like to discuss here is the consequences of cerebellar cognitive affective syndrome, otherwise known as Schmahmann’s syndrome. From what I have researched it is a common ground for people who experience bipolar, ADHD, depression, schizophrenia, Down syndrome and a whole other world of brain challenges. Recently, I was diagnosed with BPD. They think it was a result of the damage to my cerebellum. The cerebellum plays a vital role as modulator in brain activity. I have mentioned before in previous posts, that the cerebellum appears to be like an equaliser, it attunes the rest of the brain. I see it, unscientifically, as the lizard brain trying to rationalise the productivity of the mammalian brain. There are a whole lot of conversations, some of them quite amusing, that could be expressed by such a dichotomy. There are also a lot of serious ones, of which we all know about but can be left for another post. What neurologists have found is a common thread between the psychological disturbances of many disorders and syndromes, and our little friend, the cerebellum.

The cerebellum is not just a fine tuner of motor function but it also is a fine tuner of cognitive and emotional states. In fact, it fine tunes function of emotions and reality. Where does this leave us? Those of us who have un-benefited from this type of injury, do we have paddles? To make matters more complicated, the left side of the cerebellum that communicates with the right side of the cerebral cortex is communicating with a side of the cerebrum less understood. To add insult to injury, to coin a phrase, very little research has gone into rehabilitating cerebellar stroke. So, every cerebellar stroke survivor is opening up new pathways for research. Pioneers is the word that comes to mind, a challenged mind, mind you.

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You sent me down a rabbit hole of research! Very interesting. Not particularly helpful with treatment options. A couple of drugs have shown some promise with attention and executive functions, Cognitive Behavioral Therapy, Attention Therapy (who knew there was such a thing?) and TMS.

I hope you will find something helpful for you. I wonder how you were diagnosed. I see it is generally neuro-psychologist who generally diagnoses after testing. I am still awaiting my own battery of tests with them. Perhaps six months away still.

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hi @Rups

Is BPD borderline personality disorder?

Whether it is or not labels like that, are, I think shorthand for “put that in the bucket with everything else that has several elements of recognisable pattern mixed with lots of other components that don’t really fit with the other things but until we understand better we’ll just lump the lot together”

One of the first papers I read after my stroke talked about the brain lesion that I had had and the Ipsilesional and contralesional hemispheres.
It was making the point that there is a suppression mechanism between the two that normally ensures messages for one side of the brain or body are not heard and interpreted by the other side and that may be elements of neuroplasticity require the learning to not suppress these messages post stroke.

I know that your stroke affected both hemispheres

The same paper was lamenting the fact that discussion still talked about the effects of damage to a side of the brain when our consciousness or mind is composed of networks of interacting brain elements.

Important networks are the Default mode network and the Salience network, Dorsal Attention network, Visual network, Limbic network, Central Executive network, sensory network et al

These networks are made from non-contiguous brain areas

For example here is the auditory network

Current research talks about brain locations using voxels or volume pixels.
A stroke that destroys one or more voxels will have implications for multiple networks.
Those networks functions will then be subject to varying degrees of functional failure and possibly over time neuroplasticity
All of your complicated possibly even complex (IE outcomes are emergent where dependencies are previous and subsequent outcomes) have to account for the above.

I haven’t seen it in a peer review paper but I speculate that the emergent consequences we have - often around three or four months have to do with the passage of time required for processes to move necrotic tissue outside of the blood brain barrier, resolve oedema etc coming to an end and the proper stock taking and attempted adjustments being emergent. There is peer reviewed speculation that fatigue comes in more than one flavour and that one of the flavours peaters out around 3 or 4 months while others are emergent at around 3 or 4 months.

I think you have raised lots of potential for discussion.
I’m given to believe that the stroke association research team have a Research Network - As far as Nigel (who has sadly left the forum but is now in a WhatsApp on this link) and I have so far discovered it has no overlap in membership nor discussion with any members of the forum. We spoke to the head and the coordinator and that dialogue is ongoing and hopefully will bear fruit in merging a two-way dialogue :slight_smile:

It would certainly be jolly good to take the sorts of topics you raised above discover what if anything is known or being researched and relay it back in close enough to layman’s terms to be understandable for sense making and possibly also for design of interventions.

These are all things that will become possible when we have peer support integrated into the wider areas where it is needed. I don’t believe the boundary described by stroke is universally the right one - ABI would be better I think because for example we share a lot of consequences and therapy needs with people with MS[1] and a host of different conditions. The TBI community likewise has overlapping needs as do many others

Caio
Simon


  1. multiple sclerosis ↩︎

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Indeed it is, along with BPD, OCD and Schmahmann’s syndrome … I’m thinking, I ought to consider collecting the set. Cerebellar cognitive affective syndrome seems to all come down to how the cerebellum modulates the information networks in the cerebrum. It’s pretty interesting stuff really, I still think this is an evolutionary glitch. The cerebrum is Sherlock Holmes to the cerebellum’s Dr Watson.

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