Division of Brain Sciences, Imperial College London, 10 E Charing Cross Campus, London, W6 8RP, UK.
J Neurol. 2014 Mar;261(3):600-3. doi: 10.1007/s00415-014-7242-x. Epub 2014 Jan 22.
Psychotic symptoms have previously been reported following right hemisphere brain injury. We sought to identify the specific neuroanatomical basis of delusions following stroke by studying a series of patients with post-stroke psychosis. Lesion overlap analysis was conducted on three individuals with delusions following right hemisphere stroke. These cases were compared with a control group of patients with similar anatomical damage. The main outcome measures were presence of delusions and presence of behavioural susceptibility. The right inferior frontal gyrus and underlying white matter, including the superior longitudinal fasciculus and anterior corona radiata, were involved in all three cases. All three had a preexisting untreated psychiatric disorder. In contrast, only one of nine control cases with equivalent lesions had evidence of previous psychiatric disorder (p = 0.0182, Fisher's exact test), and this was being treated at the time of stroke. We provide clinical evidence from patients with structural brain lesions implicating damage to the right inferior frontal lobe in the generation of persistent psychosis following stroke. We suggest that preexisting psychiatric disease provided a behavioural susceptibility to develop delusions in these individuals.
精神病症状以前曾有报道称发生在右脑损伤后。我们通过研究一系列中风后精神病患者，试图确定中风后妄想的特定神经解剖学基础。对三名右脑中风后出现妄想的患者进行了病变重叠分析。将这些病例与具有相似解剖损伤的对照组患者进行了比较。主要的观察指标是妄想的存在和行为易感性的存在。所有三个病例均累及右侧额下回和下方的白质，包括上纵束和前冠状辐射。所有三人都有未治疗的先前存在的精神疾病。相比之下，在九个具有同等病变的对照组病例中，只有一例有先前精神疾病的证据（p = 0.0182，Fisher 精确检验），且在中风时正在接受治疗。我们从结构脑损伤的患者中提供了临床证据，这些患者的右额叶下损伤与中风后持续精神病的发生有关。我们认为，先前存在的精神疾病使这些个体更容易出现妄想。
