# Crossed cerebellar diaschisis on CT perfusion in large vessel occlusion stroke: early predictors and clinical relevance in the hyperacute phase

## TL;DR

This study finds that crossed cerebellar diaschisis is common in large vessel stroke patients and is linked to factors like female sex and brain hypoperfusion.

## Contribution

The study identifies novel predictors of crossed cerebellar diaschisis in hyperacute stroke using CT perfusion data.

## Key findings

- CCD was detected in 84.4% of patients with large vessel occlusion stroke.
- Female sex and larger supratentorial hypoperfused volumes were independent predictors of CCD.
- CCD was associated with worse outcomes but not an independent predictor in multivariable analysis.

## Abstract

Crossed cerebellar diaschisis (CCD) is a pathophysiological phenomenon in ischemic stroke (IS) that remains poorly investigated, particularly with regard to its clinical impact and the factors associated with its occurrence during the hyper-acute phase. The aim of this study was to evaluate the prevalence of CCD detected by Computed Tomography Perfusion (CTP) in patients with large vessel occlusion (LVO) ischemic stroke and to identify potential predictors of CCD occurrence and its impact on clinical outcomes.

Clinical and radiological data were collected and analyzed from 256 consecutive patients with anterior circulation LVO ischemic stroke who underwent CTP. The presence of CCD was assessed through qualitative analysis of CTP perfusion maps. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the presence of CCD, as well as to determine predictors of clinical outcome.

Perfusion alterations consistent with CCD were identified in 216 patients (84.4%). In multivariable analysis, female sex (p = 0.026) and greater supratentorial hypoperfused volume assessed on mean transit time (MTT) maps (p = 0.005) were independently associated with the presence of CCD. Although CCD was associated with a higher prevalence of unfavorable functional outcome at 3 months (mRS 3–6) in univariate analysis, it was not an independent predictor of outcome in multivariable analysis.

CCD was detected on CTP in a high proportion of patients with LVO stroke. Female sex and larger supratentorial hypoperfused volumes were independent predictors of CCD. Although correlated to functional outcome, CCD was not an independent predictor.

The online version contains supplementary material available at 10.1007/s00415-026-13750-z.