Cerebellum involvement in post-stroke mood: A combined ecological and MRI study

Sui

et al. 2016

Cell Physiol Biochem

Background: To study morphological and metabolic changes of cerebellum with multimodality magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (¹H-MRS), respective, to explore correlation between cerebellum alteration and severity of depression in patients with post-stroke depression. Methods: 60 subjects, including 40 stroke patients and 20 healthy volunteers were enrolled. Depression of stroke patients was tested by Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD), based on which stroke-patients were grouped into post-stroke depression (PSD group) and without post-stroke depression (CONT group). Results: Volume of cerebellum decreased in PSD group and CONT group compared with healthy volunteer (NORM) group. White matter of cerebellum in PSD group and CONT group was disrupted; such disruption was significantly in PSD group. In addition, there was correlation between cerebellum volume and FA and HDRS scores (P<00.01). The Cho/Cr and Cho/NAA ratios in cerebellum contralateral to stroke lesion in PSD were higher than those in NORM group (P<0.05). Cho/Cr and Cho/NAA ratios in contralateral cerebellum and ratio difference of Cho/Cr in bilateral cerebellum were positively correlated with HAMD scales (P<0.05). Conclusion: Morphologic and metabolic alterations are evident in patients with post-stroke depression, indicating possible involvement of cerebellum in post-stroke-depression occurrence.

Section: Cell Physiolsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Cell Physiolmentioning

confidence: 99%

See 1 more Smart Citation

Morphological and Metabolic Alteration of Cerebellum in Patients with Post-Stroke Depression

Sui

et al. 2016

Cell Physiol Biochem

“…But in the field of depression, many studies also found the change of cerebellar function in depression patients through functional MRI (fMRI) technique. Besides, many studies have displayed that the cerebellar structure varies, which necessarily leads to the functional changes [11, 27, 28]. Lassalle-Lagadec et al found significantly decreased volume of PSD patients’ cerebellum [28].…”

Section: Discussionmentioning

confidence: 99%

“…Besides, many studies have displayed that the cerebellar structure varies, which necessarily leads to the functional changes [11, 27, 28]. Lassalle-Lagadec et al found significantly decreased volume of PSD patients’ cerebellum [28]. Moreover, the magnetic resonance diffusion tensor imaging study about depression also showed obvious abnormality of patients’ cerebellar white matter network.…”

Section: Discussionmentioning

confidence: 99%

Proton Magnetic Resonance Spectroscopy Study on the Metabolism Changes of Cerebellum in Patients with Post-Stroke Depression

Sui²

2017

Cell Physiol Biochem

Objective: To study the metabolic changes of cerebellum by proton magnetic resonance Spectroscopy (¹H-MRS) and discuss the relationships between the cerebellar changes and depression severity in patients with post-stroke depression. Methods and Results: Data of demographic characteristics, individual history and life style of all subjects were collected. 40 patients with stroke and 20 controls were enrolled. All groups received T1WI, T2WI, DWI and ¹H-MRS examination. The cerebral infarction volume and the distribution and severity of leukoaraiosis were evaluated. The ratios of NAA/Cr, Cho/Cr and Cho/NAA in the cerebellum were calculated. There were no statistical significant difference in the NAA/Cr, Cho/Cr and Cho/NAA ratios in bilateral cerebellum between CONT group and NORM group. The Cho/Cr and Cho/NAA ratios in the cerebellum contralateral to the stroke region were higher in PSD group than those in NORM and CONT groups, and the Cho/Cr and Cho/NAA ratios in the cerebellum ipsilateral to the stroke region were similar with those in NORM and CONT groups. However, there were no statistical significant difference in the NAA/Cr ratios in bilateral cerebellum among three groups. Conclusion: The result shows preliminarily that the cerebellum involves in the development of post-stroke depression.

Impulsive aggressive obsessions following cerebellar strokes: a case study

et al. 2015

Self Cite

Dear Sirs,Out of the total ischemic stroke events, about 4 % of them affect the cerebellum [1]. Traditionally, studies on cerebellar function have focused on the motor functions. It is clear now that the cerebellum underlies numerous nonmotor networks [2] and has a role not only in higher cognitive functions [3], but also in emotional and behavioral processing [4].''Mr. M'' is a 56-year-old left-handed man with 11 years of educational level and was professionally active (baker). His medical history reveals neither significant previous medical history nor any mental disorder.He was admitted for a sudden vertigo and dysarthria and left paresthesia. Brain MRI showed a right cerebellar punctiform infarction (lobule VI). A stroke recurrence occurred few days later, with similar minor symptoms. Brain MRI demonstrated a new ischemic lesion in the left superior cerebellar artery territory (lobule VI), and in a right perforating branch of the pons (pyramidal tract) ( Fig. 1).In the acute phase of stroke, Mr. M presented a moderate level of anxiety, but he had no apathy, depression or cognitive disorders when assessed by reliable scales (data available on request). Five months after stroke, the patient started to experience invasive obsessive thoughts leading to an important distress. The content of these obsessions focus on an unacceptable theme: stabbing a relative. The intensity of these obsessions was associated with daily life alteration, avoidance behavior and anxiety. In the distress to an immediate hetero-aggressive gesture by cold steel on his daughter, he committed impulsive suicide attempts by drowning. In this context, he was hospitalized in a psychiatric hospital with the final diagnosis of obsessivecompulsive disorder (OCD) complicated by a major depressive disorder (MDD). Following the recent guidelines for pharmacotherapy in OCD [5], first-line selective serotonin reuptake inhibitor (SSRI) (escitalopram, sertraline, paroxetine) then second-line antidepressant (venlafaxine) until the dosage of 225 mg/day with antipsychotic as adjunctive therapy (risperidone 2 mg/day) were tried but they failed. At last, the combination of diazepam (20 mg/day), paroxetine (40 mg/day) and quetiapine (100 mg/day) was efficient for MDD but failed to significantly improve the impulsive aggressive obsessions leading to recurrent hospitalizations. Cognitive behavioral therapy (CBT) was tried but was unfortunately poorly efficient on obsessions.A meta-analysis in 2008 reported that lobule VI is involved in emotional processing by a cerebellar-limbic circuit [6]. Chronology and infarct localization suggest that the second cerebellar stroke, involving lobules VI and Crus I, was preferentially responsible of the onset of psychiatric disorder and fully supports our hypothesis. However, we cannot exclude the potential influence of the first stroke's stress, or the influence of bilateral lesions.The cerebellum seems to be less activated in patients with OCD [7,8], but there is a lack of studies exploring the clinical implications of this ...