Evidence of Cerebellar Involvement in the Onset of a Manic State.

We described the cerebello-cerebral functional connectivity in a subject who developed a manic state after a cerebellar lesion. Whole brain investigation, performed by means of an advanced MRI examination, evidenced an isolated lesion involving the left lobules VI, VIIa (crus I), and IX and the posterior area of the vermis. The cerebello-cerebral functional connectivity analysis detected a pattern of altered connectivity in specific areas of the prefrontal-striatal-thalamic circuits that are typically altered in bipolar subjects during the manic state. Specifically, a pattern of hypo-connectivity was found between the cerebellum and cerebral regions known to be implicated in emotion modulation and social interaction. Conversely, a pattern of hyper-connectivity was found between the cerebellum and posterior cerebral cortical regions that are involved in sensorimotor functions. The present study represents the first evidence that dysregulation of cerebral networks consequent to a cerebellar lesion is at the root of bipolar disorder, at least the manic state, and provides a new framework for interpreting cerebellar modulation in the regulation of mood in specific psychiatric conditions.