Sarà Marco, Cornia Riccardo, Conson Massimiliano, Carolei Antonio, Sacco Simona, Pistoia Francesca
Post-Coma Intensive Rehabilitation Care Unit, San Raffaele Hospital, Cassino, Italy.
Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy.
Front Neurol. 2018 May 17;9:354. doi: 10.3389/fneur.2018.00354. eCollection 2018.
Previous evidence suggests that hallucinations and delusions may be detected in patients with the most severe forms of motor disability including locked-in syndrome (LIS). However, such phenomena are rarely described in LIS and their presence may be underestimated as a result of the severe communication impairment experienced by the patients. In this study, we retrospectively reviewed the clinical history and the neuroimaging data of a cohort of patients with LIS in order to recognize the presence of hallucinations and delusions and to correlate it with the pontine damage and the presence of any cortical volumetric changes. Ten patients with LIS were included (5 men and 5 women, mean age 50.1 ± 14.6). According to the presence of indicators of symptoms, these patients were categorized as hallucinators ( = 5) or non-hallucinators ( = 5). MRI images of patients were analyzed using Freesurfer 6.0 software to evaluate volume differences between the two groups. Hallucinators showed a selective cortical volume loss involving the fusiform ( = 0.001) and the parahippocampal ( = 0.0008) gyrus and the orbital part of the inferior frontal gyrus ( = 0.001) in the right hemisphere together with the lingual ( = 0.01) and the fusiform gyrus ( = 0.01) in the left hemisphere. Moreover, a volumetric decrease of bilateral anterior portions of the precuneus was recognized in the hallucinators (right = 0.01; left = 0.001) as compared to non-hallucinators. We suggested that the presence of hallucinations and delusions in some LIS patients could be accounted for by the combination of a damage of the corticopontocerebellar pathways with cortical changes following the primary brainstem injury. The above areas are embedded within cortico-cortical and cortico-subcortical loops involved in self-monitoring and have been related to the presence of hallucinations in other diseases. The two main limitations of our study are the small sample of included patients and the lack of a control group of healthy individuals. Further studies would be of help to expand this field of research in order to integrate existing theories about the mechanisms underlying the generation of hallucinations and delusions in neurological patients.
先前的证据表明，在包括闭锁综合征（LIS）在内的最严重运动障碍形式的患者中，可能会检测到幻觉和妄想。然而，此类现象在闭锁综合征中很少被描述，并且由于患者经历的严重沟通障碍，其存在可能被低估。在本研究中，我们回顾性地分析了一组闭锁综合征患者的临床病史和神经影像数据，以识别幻觉和妄想的存在，并将其与脑桥损伤以及任何皮质体积变化相关联。纳入了10例闭锁综合征患者（5名男性和5名女性，平均年龄50.1±14.6岁）。根据症状指标的存在情况，将这些患者分为幻觉者（n = 5）或非幻觉者（n = 5）。使用Freesurfer 6.0软件分析患者的MRI图像，以评估两组之间的体积差异。幻觉者表现出选择性皮质体积丢失，涉及右侧半球的梭状回（p = 0.001）、海马旁回（p = 0.0008）和额下回眶部（p = 0.001），以及左侧半球的舌回（p = 0.01）和梭状回（p = 0.01）。此外，与非幻觉者相比，幻觉者双侧楔前叶前部的体积减小（右侧p = 0.01；左侧p = 0.001）。我们认为，一些闭锁综合征患者中幻觉和妄想的存在可能是由皮质脑桥小脑通路损伤与原发性脑干损伤后皮质变化共同导致的。上述区域嵌入参与自我监测的皮质-皮质和皮质-皮质下环路中，并且在其他疾病中与幻觉的存在有关。我们研究的两个主要局限性是纳入患者的样本量小以及缺乏健康个体对照组。进一步的研究将有助于扩展该研究领域，以整合关于神经疾病中幻觉和妄想产生机制的现有理论。
