MRI subcortical signal hyperintensities in Mania at first hospitalization

Strakowski, Stephen M.; Woods, Bryan T.; Tohen, Mauricio; Douglas, Andrew W.; Stoll, Andrew L.

doi:10.1016/0006-3223(93)90140-9

Cited by 74 publications

(52 citation statements)

References 9 publications

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“…Similarly, untreated BD patients with a first psychotic episode had increased radial diffusivity compared with healthy controls in several WM tracts including the cingulum, internal capsule, and longitudinal fasciculus, suggesting a neurodevelopmental disorganization of WM tracts and/or aberrant myelination of fibers (Lu et al, 2011). Potentially congruent with the DTI data, Strakowski et al (1993) reported an increased frequency of white matter hyperintensities (WMH) in first-episode adult patients with BD.…”

Section: Evidence For a Neurodevelopmental Etiologymentioning

confidence: 53%

Neuropathological and neuromorphometric abnormalities in bipolar disorder: View from the medial prefrontal cortical network

Savitz

Price

Drevets

2014

Neuroscience & Biobehavioral Reviews

125

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Section: Evidence For a Neurodevelopmental Etiologymentioning

confidence: 53%

Neuropathological and neuromorphometric abnormalities in bipolar disorder: View from the medial prefrontal cortical network

Savitz

Price

Drevets

2014

Neuroscience & Biobehavioral Reviews

125

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“…Second, various studies had different thresholds for reporting hyperintensities. For example, Strakoswki et al (1993) and Altshuler et al (1995) noted subcortical hyperintensities if they were 2 mm or larger. Persaud et al (1997), Ahearn et al (1998), and McDonald et al (1999) identified hyperintensities larger than 1 mm.…”

Section: Resultsmentioning

confidence: 99%

“…Many early studies have demonstrated an association between subcortical hyperintensities and bipolar illness (Aylward et al, 1994; Dupont et al, 1995b; Figiel et al, 1991; Swayze et al, 1990). Not all investigators have found a significantly greater prevalence of these lesions in bipolar patients (Brown et al, 1992; Lewine et al, 1995), but many of the negative studies have found trends toward a relationship (Altshuler et al, 1995; Botteron et al, 1995; Persaud et al, 1997; Strakowski et al, 1993), and most of these studies used a relatively small sample with a large range in ages. When meta-analytic tests were applied to these early studies, a strong odds ratio for hyperintensities in bipolar subjects was noted (Altshuler et al, 1995; Videbech, 1997).…”

Section: Introductionmentioning

confidence: 99%

Hyperintense MRI lesions in bipolar disorder: A meta-analysis and review

Beyer

Young

Kuchibhatla

et al. 2009

International Review of Psychiatry

121

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Background Cortical and subcortical hyperintensities in magnetic resonance imaging (MRI) scans are thought to represent areas of ischemic damage to brain tissue. Researchers have focused on the possible role these lesions may have in psychiatric disorders, including bipolar disorder. In 1997, the proposed ‘vascular mania’ diagnosis suggested utilizing not only the presence of strokes, but also confluent hyperintensities in its diagnostic criteria. This study was conducted to use meta-analytic techniques to investigate the association of hyperintensities and bipolar illness and to evaluate the current state of the literature. Methods Using the PubMed and MEDLINE databases, we conducted a systematic literature search of studies investigating hyperintensities in subjects with bipolar disorder and controls or other psychiatric illnesses. We identified 44 publications from which 35 studies were included for review and 27 were selected for meta-analysis. Summary statistics of the prevalence were estimated through odds-ratios and confidence interval. Heterogeneity of the results across studies was tested using Q-statistics. Results Meta-analysis identified an odds ratio of 2.5 (95% CI 1.9, 3.3) for hyperintensities in bipolar subjects compared to controls; however, there was significant heterogeneity among the studies (Q-statistics =32; p =0.04). This finding was most prominent for adolescents and children where the odds ratio was 5.7 (95% CI 2.3, 13.7). Deep white matter hyperintensities (odd ratio 3.2; 95% CI 2.2, 4.5) and subcortical grey matter hyperintensities (odds ratio 2.7; 95% CI 1.3, 2.9) were more strongly associated with bipolar subjects. There were no differences between bipolar subjects and controls for perivascular hyperintensities (odds ratio 1.3; 95% CI 0.8, 1.9). Though hyperintensities were numerically greater in bipolar subjects, meta-analysis did not demonstrate any significant differences between bipolar subjects and unipolar depression subjects (OR 1.6; 95% CI 0.9, 2.7) nor subjects with schizophrenia (OR 1.5; 95% CI 0.9, 2.7). Conclusions This meta-analysis continues to support the association of bipolar disorder and hyperintensities, especially in the deep white matter and subcortical grey matter. It also highlights the increased incidence in children and adolescence with bipolar disorder. However, hyperintensities are not specific to bipolar disorder, but appear at similar rates in unipolar depression and schizophrenia. Thus, the role of hyperintensities in the pathogenesis, pathophysiology, and treatment of bipolar disorder remains unclear. Further studies are required that are large enough to decrease the heterogeneity of the samples and MRI techniques, assess size and location of hyperintensities, and the impact on treatment response. Coordination with newer imaging techniques, such as diffusion tensor imaging (DTI) may be especially helpful in understanding the pathology of these lesions.

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“…and K.W.S.). 20,25,33 For all ROIs except the cerebrum, areas were measured in every slice in which the structures were visualized, and volumes were calculated by multiplying by slice thickness (1 mm). For the cerebrum, every fifth slice was measured and the volume calculated by multiplying by 5 mm.…”

Section: Image Acquisition and Analysismentioning

confidence: 99%

Brain Magnetic Resonance Imaging of Structural Abnormalities in Bipolar Disorder

Strakowski

DelBello

Sax

et al. 1999

Arch Gen Psychiatry

Self Cite

585

368

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Background:The neuropathogenesis of bipolar disorder remains poorly described. Previous work suggests that patients with bipolar disorder may have abnormalities in neural pathways that are hypothesized to modulate human mood states. We examined differences in brain structural volumes associated with these pathways between patients with bipolar disorder hospitalized with mania and healthy community volunteers.Methods: Twenty-four patients with bipolar disorder and mania were recruited from hospital admission records. Twenty-two healthy volunteers were recruited from the community who were similar to the patients in age, sex, race, height, handedness, and education. All subjects were scanned using a 3-dimensional radiofrequency-spoiled Fourier acquired steady state acquisition sequence on a 1.5-T magnetic resonance imaging scanner. Scans were analyzed using commercial software. Prefrontal, thalamic, hippocampal, amygdala, pal-lidal, and striatal volumetric measurements were compared between the 2 groups.Results: Patients with bipolar disorder demonstrated a significant (⌳ = 0.64; F 6,37 = 3.4; P = .009) overall difference in structural volumes in these regions compared with controls. In particular, the amygdala was enlarged in the patients. Brain structural volumes were not significantly associated with duration of illness, prior medication exposure, number of previous hospital admissions, or duration of substance abuse. Separating patients into first-episode (n = 12) and multiple-episode (n = 12) subgroups revealed no significant differences in any structure (PϾ.10). Conclusion:Patients with bipolar disorder exhibit structural abnormalities in neural pathways thought to modulate human mood.

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MRI subcortical signal hyperintensities in Mania at first hospitalization

Cited by 74 publications

References 9 publications

Neuropathological and neuromorphometric abnormalities in bipolar disorder: View from the medial prefrontal cortical network

Neuropathological and neuromorphometric abnormalities in bipolar disorder: View from the medial prefrontal cortical network

Hyperintense MRI lesions in bipolar disorder: A meta-analysis and review

Brain Magnetic Resonance Imaging of Structural Abnormalities in Bipolar Disorder

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