1419 - Dissociative Episodes Following Cerebellar Hemorrhage: A Case Report

Case Diagnosis: Dissociative and Psychotic Episodes Following Cerebellar Hemorrhage

Case Description: A 41-year-old male suffered a cerebellar hemorrhage due to arteriovenous malformation rupture, leading to dissociative and psychotic episodes. One month after the event, he experienced 30-minute episodes of unresponsiveness with open eyes but no reactions to verbal, tactile, or noxious stimuli. Initially, anti-epileptic drugs were administered due to suspected seizures, but EEG results showed no epileptiform activity during an episode of altered mental status, so AEDs were discontinued. During rehabilitation, he displayed strange thought processes, alternating between normal cognition and paranoid or illogical thoughts, such as wanting to go to the ICU or embassy and fixating on HIV. Two weeks later, he exhibited a distinct dissociative episode, only responding when his name was mentioned at the beginning of each phrase or question. Strangely, he had no memory of these episodes. Over time, his cognitive function improved, leading to a reduction and eventual cessation of these episodes.

Discussions: Cerebellar Cognitive Affective Syndrome (CCAS) can manifest after cerebellar hemorrhages. The underlying theory suggests the disruption of neural connections between the cerebellum and the limbic system, as well as the prefrontal cortex, leads to cognitive and behavioral-affective abnormalities. While previous research has primarily concentrated on affective manifestations such as depression and anxiety, this case introduces a distinctive presentation involving dissociative symptoms, characterized by absence of response noxious stimuli and perseverative and psychotic thought processes

Conclusions: This case highlights the importance of recognizing and distinguishing CCAS from seizures in patients who have suffered cerebellar strokes. Neglecting to do so can impede progress in rehabilitation. The study emphasizes the need for further research to enhance our comprehension of CCAS and to differentiate it from other potential causes of similar symptoms. Ultimately, this will contribute to the development of more effective therapies and management strategies for individuals affected by CCAS.