Starkstein S E, Fedoroff P, Berthier M L, Robinson R G
Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Biol Psychiatry. 1991 Jan 15;29(2):149-58. doi: 10.1016/0006-3223(91)90043-l.
Although mania is a rare complication of brain lesions, recent reports have emphasized the importance of lesion location and genetic predisposition in these patients. In the present study we compared patients who developed a bipolar affective disorder (i.e., mania and depression) after a brain lesion with patients who only developed mania. Although no significant between-group differences were found on demographic variables, the manic-depressed group showed significantly more impairments on the Mini Mental State Exam than the mania only group. All the bipolar patients had subcortical lesions (mainly right head of the caudate and right thalamus), while patients with unipolar mania had significantly higher frequency of cortical involvement (mainly right orbitofrontal and basotemporal cortices). It is suggested that subcortical and cortical right hemisphere lesions may produce different neurochemical and/or remote metabolic brain changes that may underlie the production of either a bipolar disease or a unipolar mania.
虽然躁狂是脑损伤的一种罕见并发症，但最近的报告强调了病变位置和遗传易感性在这些患者中的重要性。在本研究中，我们将脑损伤后出现双相情感障碍（即躁狂和抑郁）的患者与仅出现躁狂的患者进行了比较。虽然在人口统计学变量上未发现显著的组间差异，但双相情感障碍组在简易精神状态检查表上的损伤明显多于仅患躁狂症的组。所有双相情感障碍患者都有皮质下病变（主要是右侧尾状核头部和右侧丘脑），而单相躁狂症患者皮质受累的频率显著更高（主要是右侧眶额皮质和基底颞叶皮质）。有人提出，右侧半球皮质下和皮质病变可能会产生不同的神经化学和/或远距离代谢性脑变化，这可能是双相情感障碍或单相躁狂症产生的基础。
