Herrmann M, Bartels C, Schumacher M, Wallesch C W
Department of Rehabilitation Psychology, University of Freiburg, Germany.
Stroke. 1995 May;26(5):850-6. doi: 10.1161/01.str.26.5.850.
This study is aimed at the pathoanatomic correlates of depression in the postacute stage of patients with stroke.
Of a consecutive series of 104 stroke patients, a subgroup of 47 patients with single demarcated unilateral lesions was selected. Clinical examination, neuroradiological CT scan examination, and psychiatric assessment were performed within a 2-month period after the acute stroke. Depression was assessed with the Cornell Depression Scale, the Montgomery-Asberg Depression Rating Scale, and according to modified DSM-III-R criteria. The neuroradiological examination of all patients was performed on the same scanner, and lesion location, lesion volume, and ventricle-to-brain ratio were analyzed.
We found no significant differences in depression scores between patients with left and right hemisphere lesions and no correlation between the severity of depression and the anteriority and the volume of lesion or brain atrophy. Major depressive disorders were only found in nine patients with left hemisphere lesions, all involving the basal ganglia, whereas none of the patients with right hemisphere stroke exhibited major depression.
Lesions in the vicinity of the left hemisphere basal ganglia tend to play a crucial role in the development of major depression after the acute stage of stroke. The pathophysiological implications of this finding are discussed.
本研究旨在探讨脑卒中患者急性期后抑郁的病理解剖学相关性。
在连续收治的104例脑卒中患者中，选取47例单侧界限性病灶患者作为亚组。在急性脑卒中发作后2个月内进行临床检查、神经放射学CT扫描检查及精神评估。采用康奈尔抑郁量表、蒙哥马利-阿斯伯格抑郁评定量表，并依据修订的DSM-III-R标准评估抑郁情况。所有患者的神经放射学检查均在同一台扫描仪上进行，分析病灶位置、病灶体积及脑室与脑体积比。
我们发现，左、右半球病灶患者的抑郁评分无显著差异，抑郁严重程度与病灶的前部位置、病灶体积或脑萎缩之间也无相关性。仅在9例左半球病灶患者中发现重度抑郁症，所有患者均累及基底神经节，而右半球脑卒中患者无一例出现重度抑郁。
左半球基底神经节附近的病灶在脑卒中急性期后重度抑郁的发生中往往起关键作用。本文讨论了这一发现的病理生理学意义。
