Persistent executive, visuospatial, and conceptual deficits after right posterior cerebellar infarction

Background: The cerebellum has traditionally been regarded as a structure primarily involved in motor coordination. However, accumulating evidence indicates that the cerebellum can exert substantial influence on cognitive and emotional processes. These findings suggest that the cerebellum may play a broader role in higher-order cognitive functions than previously recognized. Case Presentation: A right-handed Japanese man in his 80s with no significant prior medical history developed cognitive and behavioral symptoms following an infarction involving the right posterior cerebellar lobe and vermis, corresponding to the right posterior inferior cerebellar artery territory. Emotional lability, disorientation, and memory impairment emerged during the subacute phase but gradually improved. In contrast, executive dysfunction, perseveration, and visuospatial impairment persisted. On the Clock Drawing Test, errors such as misplacement of numbers and incorrect representation of time were observed, which could not be explained by visuospatial deficits and suggested impairment of conceptual aspects of cognition. Conclusion: This case demonstrates that a right posterior cerebellar infarction can result in persistent impairments in executive, visuospatial, and conceptual functions. These findings suggest that cerebellar injury may affect higher-order cognition not only through disruption of cerebello-cerebral connectivity, but also through impairment of the cerebellum's modulatory role in the regulation of complex cognitive operations.