Before there was a cortex – How cerebellar neuropsychiatric syndromes may provide insight into more common prefrontal psychiatric disorders

Abstract: Neuropsychiatric syndromes from disruption in affect, cognition, attention, and catatonia, have traditionally implicated dysfunction in prefrontal and other cortical regions. Rarely, however, neuropsychiatric symptoms due to cerebellar and brainstem dysfunction can also occur. Herein we discuss the several cerebellar and brainstem neuropsychiatric syndromes and how they can inform us about evolutionary psychology and potential neurotransmitter targets for more common neuropsychiatric disorders.



In the first session, Dr. Denysenko will introduce the cerebro-limbico-cerebellar circuit, and how cerebellar dysfunction, in particular regard to post-surgical cerebellar mutism in children, implicates a role for sigma receptor pathophysiology which in turn, may inform of innovative treatment considerations regarding pseudobulbar affect in older adults. (20 mins)



In the second section, Dr. Ganguly will build upon the neural circuitry discussed by Dr. Denysenko, and then elaborate on the various neuropsychiatric syndromes precipitated by the various brainstem lesions. Cases related to such will also be demonstrated. In addition, the role of the brainstem and cerebellum in evolutionary psychology will be reviewed. (20 mins)



In the third session, Dr. Kaur will give an overview of cerebellar cognitive affective syndrome (CCAS), initially described by Dr. Schmahmann and colleagues in the 1990's. Cases of paraneoplastic syndrome and Erdheim-Chester Disease presenting with key features of CCAS will be presented. (20 mins)





Participation from the audience will be encouraged throughout, and interaction will be solicited through electronic voting, with additional time for traditional question and answer session at the end. (15 mins)

Learning Objectives:

• - Identify the basic neuropsychiatric signs and symptoms of various cerebellar syndromes that may present in the inpatient C-L service setting
• - Describe the role of the cerebellum and brainstem in the presentation of various neuropsychiatric syndromes.
• - Appreciate the significance of the subcortical structures in the evolution of human emotional repertoire.