RESUMO
BACKGROUND: Neurodevelopmental alterations have been described inconsistently in psychosis probably because of lack of standardization among studies. The aim of this study was to conduct the first longitudinal and population-based magnetic resonance imaging (MRI) evaluation of the presence and size of the cavum septum pellucidum (CSP) and adhesio interthalamica (AI) in a large sample of patients with first-episode psychosis (FEP). METHOD: FEP patients (n=122) were subdivided into schizophrenia (n=62), mood disorders (n=46) and other psychosis (n=14) groups and compared to 94 healthy next-door neighbour controls. After 13 months, 80 FEP patients and 52 controls underwent a second MRI examination. RESULTS: We found significant reductions in the AI length in schizophrenia FEP in comparison with the mood disorders and control subgroups (longer length) at the baseline assessment, and no differences in any measure of the CSP. By contrast, there was a diagnosis×time interaction for the CSP length, with a more prominent increase for this measure in the psychosis group. There was an involution of the AI length over time for all groups but no diagnosis×time interaction. CONCLUSIONS: Our findings suggest that the CSP per se may not be linked to the neurobiology of emerging psychotic disorders, although it might be related to the progression of the disease. However, the fact that the AI length was shown to be shorter at the onset of the disorder supports the neurodevelopmental model of schizophrenia and indicates that an alteration in this grey matter junction may be a risk factor for developing psychosis.
Assuntos
Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Transtornos do Humor/diagnóstico , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Septo Pelúcido/anormalidades , Septo Pelúcido/patologia , Tálamo/anormalidades , Tálamo/patologia , Adulto , Brasil , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Transtornos do Humor/epidemiologia , Tamanho do Órgão , Transtornos Psicóticos/epidemiologia , Valores de Referência , Fatores de Risco , Esquizofrenia/epidemiologia , Fatores Sexuais , Adulto JovemRESUMO
Idiopathic generalized epilepsies (IGE) are a group of frequent age-related epilepsy syndromes. IGE are clinically characterized by generalized tonic-clonic, myoclonic and absence seizures. According to predominant seizure type and age of onset, IGE are divided in subsyndromes: childhood absence and juvenile absence epilepsy (AE), juvenile myoclonic epilepsy (JME) and generalized tonic-clonic seizures on awakening (GTCS). The limits between these subsyndromes are not well defined, supporting the existence of only one major syndrome. Visual assessment of routine magnetic resonance imaging (MRI) in patients with IGE is normal. MRI voxel-based morphometry (VBM) uses automatically segmented gray and white matter for comparisons, eliminating the investigator bias. We used VBM to study 120 individuals (47 controls, 44 with JME, 24 with AE and 15 with GTCS) to investigate the presence of subtle structural abnormalities in IGE subsyndromes. VBM was performed searching for abnormalities on gray matter concentration (GMC) between patients groups and controls. Compared to controls, JME presented increased GMC in frontobasal region and AE showed increased GMC in the superior mesiofrontal region. The GTCS group did not differ from controls. There were no areas of reduced GMC with the statistical level selected. Region of interest analysis showed increased GMC in the anterior portion of the thalamus in patients with absence seizures. Our results support subtle GMC abnormalities in patients with JME and AE when compared to controls. These findings suggest the existence of different patterns of cortical abnormalities in IGE subsyndromes.
Assuntos
Encéfalo/anormalidades , Encéfalo/patologia , Epilepsia Generalizada/patologia , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Computação Matemática , Adolescente , Adulto , Córtex Cerebral/anormalidades , Córtex Cerebral/patologia , Ventrículos Cerebrais/anormalidades , Ventrículos Cerebrais/patologia , Coristoma/patologia , Dominância Cerebral/fisiologia , Epilepsia Tipo Ausência/patologia , Epilepsia Tônico-Clônica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Epilepsia Mioclônica Juvenil/patologia , Neurônios , Valores de Referência , Software , Tálamo/anormalidades , Tálamo/patologiaRESUMO
Several studies have independently suggested that patients with schizophrenia are more likely to have an enlarged cavum septum pellucidum (CSP) and an absent adhesio interthalamica (AI), respectively. However, neither finding has been consistently replicated and it is unclear whether there is an association between these two midline brain abnormalities. Thus, we compared the prevalence of absent AI and the prevalence, size and volume of CSP in 38 patients with schizophrenia and 38 healthy controls using magnetic resonance imaging (MRI). There were no between group differences in the presence or volume of CSP; however, an enlarged CSP was commoner among patients than controls. There was also a positive correlation between CSP ratings and volumes. No differences in the presence or absence of the AI were found between patients and controls; however, an absent AI was commoner in male patients with schizophrenia than females. There was absolutely no overlap between the presence of a large CSP and an absence of AI. In conclusion, our findings are in line with several case series and other MRI investigations that have shown a higher incidence of putatively developmental brain abnormalities in patients with schizophrenia, particularly in males, and support the neurodevelopmental model of this disorder.
Assuntos
Imageamento por Ressonância Magnética , Esquizofrenia/diagnóstico , Septo Pelúcido/anormalidades , Septo Pelúcido/patologia , Tálamo/anormalidades , Tálamo/patologia , Adulto , Comorbidade , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes , Esquizofrenia/patologia , Caracteres SexuaisRESUMO
A previous study reported that adult mice irradiated at the 16th embryonic day present a severe neuronal number reduction in the dorsal lateral geniculate thalamic nucleus. In the present study, we investigated the time course of the effects of prenatal irradiation on this thalamic nucleus. One day after irradiation, a great number of pyknotic figures were seen mainly in the cerebral proliferative zones. In the geniculate nucleus, only scattered pyknotic figures were identified. On the first week after birth, the geniculate nucleus presented frequent pyknotic figures. From five days after birth onwards, a severe shrinkage of the occipital cortex and a great reduction in the geniculate nucleus neuronal number were found. On the second week after birth this neuronal number reduction reached as high as 75%. At each postnatal analyzed age, severe volumetric geniculate nucleus shrinkage was combined to non-significant neuronal density variations. The presence of few pyknotic figures in the geniculate nucleus one day after irradiation and its delayed neuronal loss indicate an indirect effect of irradiation. We suggest that the effect upon the geniculate nucleus is secondary to the damage of the occipital cortex. A possible interpretation for thalamic neuronal loss is that geniculate neurons fail to establish cortical arbors after major target loss. In this case, the loss of trophic support should also be considered.
Assuntos
Diferenciação Celular/fisiologia , Raios gama , Corpos Geniculados/anormalidades , Neurônios/metabolismo , Degeneração Retrógrada/fisiopatologia , Córtex Visual/anormalidades , Vias Visuais/anormalidades , Envelhecimento/fisiologia , Envelhecimento/efeitos da radiação , Animais , Apoptose/fisiologia , Apoptose/efeitos da radiação , Contagem de Células , Diferenciação Celular/efeitos da radiação , Divisão Celular/fisiologia , Divisão Celular/efeitos da radiação , Núcleo Celular/metabolismo , Núcleo Celular/patologia , Núcleo Celular/efeitos da radiação , Tamanho Celular/fisiologia , Tamanho Celular/efeitos da radiação , Feminino , Corpos Geniculados/patologia , Corpos Geniculados/efeitos da radiação , Masculino , Camundongos , Neocórtex/anormalidades , Neocórtex/patologia , Neocórtex/efeitos da radiação , Neurônios/patologia , Neurônios/efeitos da radiação , Degeneração Retrógrada/etiologia , Degeneração Retrógrada/patologia , Tálamo/anormalidades , Tálamo/patologia , Tálamo/efeitos da radiação , Córtex Visual/patologia , Córtex Visual/efeitos da radiação , Vias Visuais/patologia , Vias Visuais/efeitos da radiaçãoAssuntos
Humanos , Doenças Talâmicas/classificação , Doenças Talâmicas/complicações , Doenças Talâmicas/diagnóstico , Doenças Talâmicas/epidemiologia , Doenças Talâmicas/etiologia , Doenças Talâmicas/fisiopatologia , Doenças Talâmicas/mortalidade , Doenças Talâmicas/tratamento farmacológico , Doenças Talâmicas/terapia , Tálamo/anormalidades , Tálamo/fisiopatologiaRESUMO
En la unidad de Neurología del Centro Hospitalario San Juan de Dios de Bogotá, durante cuatro años (1986 a 1989), se estudiaron en forma consecutiva 25 pacientes con lesiones talámaticas no fatales. Se registraron los hallazgos neurológicos, neurosicológicos y neurooftalmológicos y los diagnósticos se confirmaron por tomografía computarizada (TC). Fueron 14 mujeres y 11 varones con una edad promedio de 52.5 y un rango de 25 a 84 años. La lesión talámica fue de origen vascular en 24 casos, ocho por infarto isquémico, cuatro por infarto hemorrágico y 12 con hematomas parenquimatosos. Diecisiete pacientes tenían hipertensión arterial sistémica y el único factor de riesgo en otros dos era el consumo de cocaína base (basuco). Ocho infartos se presentaron en el tálamo derecho, 12 en el izquierdo y cinco pacientes tuvieron lesiones bilaterales, uno de ellos con un glioma complobado por biopsia. En 5 pacientes con lesiónes bilateral se observó el síndrome del "Tope" de la arteria basilar, por compromiso del pedículo retromamilar; en todos ellos encontramos alteraciones sensitivomotoras, cerebelosas, oculomotoras bilaterales y demencia. Solamente un paciente presentó el clasicó síndrome de hiperpatía (Dejerine-Roussy). En los restantes se observaron asociaciones de síndromes sensitivomotores, cerebelosos, neurooftalmológicos, neuropsicológicos, y del comportamiento motor que remedan con frecuencia los hallazgos clínicos de la alteración cortical frontal, temporal o parietal.