Mesial temporal cortex hypoperfusion is associated with depression in subcortical stroke.

Abstract

Background and Purpose This study was conducted to evaluate local cerebral blood flow changes in patients with depression after a subcortical stroke.Methods Clinical and neuropsychological assessments were performed in 15 patients with a single subcortical lesion. Depression was assessed by DSM-III-R. In addition, the Hamilton Rating Scale for depression, the Zung Self-Rating Depression Scale, and the Beck scale were administered to each patient. Single-photon emission-computed tomography study was performed with " T C hexamethylpropyleneamine oxime.Results In all patients cortical regions ipsilateral to subcortical lesions were significantly less perfused than the contra-

Poststroke depression: Prevalence, course, and associated factors

“…Despite the associations found between lesions in the parieto-occipital regions of the right hemisphere and PSD (Yamaguchi et aL, 1992), other studies have found no significant relationship between the affected hemisphere and the presence of PSD (Grasso et al, 1994;. Similar to the study by Yamaguchi et al, Grasso et al examined cerebral blood flow in 15 patients with subcortical strokes (mean age = 67.8 years, SD = 9.6), at a mean time poststroke of 2.5 months (SD = 1.5).…”

“…While some studies have found no link between lesion volume and depression (Astrom, Adolfsson, and Asplund, 1993;Grasso et al, 1994;, other studies have reported a positive relationship in which PSD is present in patients with large lesions Schwartz et al, 1990;Sharpe et al, 1994). Morris, Robinson, Andrzejewski et al (1993) examined the relationship between PSD and mortality in 91 stroke patients (mean age = 49.7 years, SD = 12.6) over a 10 year period.…”

“…Fedoroff et al (1991) found that the depressed stroke patients were younger on average (mean age = 56.5 years, SD = 12) than those who were not depressed (mean age = 60.4 years, SD = 14). However, these age differences are small, and many other researchers have found no correlation between age and PSD (Andersen, Vestergaard, Riis and Lauritzen, 1994;Grasso et aL, 1994;Parikh et al, 1990;Shima et aL, 1994). Andersen, Vestergaard, Riis, and Lauritzen (1994) examined the course of PSD in the first year poststroke in 285 stroke patients.…”

Affective Disorders following Stroke

“…The hypothetical mechanisms considered by those au thors supporting the role of lesion location are based on the observation of a higher incidence of familial psychiat ric disorders in patients with a right posterior lesion, which might suggest differential vulnerability to depres sion for right and left lesions [ 15], Both PET studies show ing a possible compensatory upregulation of 5-HT2 (sero tonin) receptors in the RH after stroke, which is not seen after left-sided lesions [42], and animal studies showing a lateralized biochemical response to ischemia, suggesting asymmetry in the human biological response to injury, support this view [43], However, the finding of temporolimbic hypoperfusion in patients with depression and sub cortical stroke suggests that alternative mechanisms might be involved [44], Treatment Nortriptyline, trazodone and serotonin re-uptake in hibitors [19][20][21] were shown to be effective in randomized placebo-controlled studies of poststroke depression. Be cause of the high frequency of their contraindication and adverse effects (orthostatic hypotension, atrioventricular block), tricyclic antidepressives are not the first choice in cerebrovascular patients [45], Serotonin re-uptake inhibi tors may be the best choice [20,21]; however, adverse reactions such as fluoxetine-induced mania in a patient with poststroke depression can occur [46], Open trials have suggested the potential benefit of psychostimulants (methylphenidate), but further controlled studies are re quired to reach a conclusion [45], Imipramine and mianserine have been effective in trials, and imipramine proba bly has a combined action on the noradrenergic and espe cially the serotonergic systems [45], The potential benefit of electroconvulsive therapy may warrant confirmation [45,47], Treatment against spasticity, psychological assis tance and social support should not be neglected [48].…”

Associação entre o episódio depressivo maior após acidente vascular cerebral isquêmico e comprometimento de circuitos neuronais pela lesão: um estudo prospectivo de 4 meses

“…Na primeira revisão sistemática publicada em 1998 (Singh, Herrmann et al 1998 (Grasso, Pantano et al 1994). Para os autores este resultado pode refletir uma disfunção do sistema límbico, a qual pode ser uma região crítica para a ocorrência de depressão nos pacientes com AVC.…”