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MEDICINA (2003) Vol. 39, No. 2 - http://medicina.kmu.lt
Mental disorders and their relation to brain lesion location:
diagnostical problems
Devika Gudienė, Benjaminas Burba
Clinic of Psychiatry, Kaunas University of Medicine Hospital, Lithuania
Key words: organic cerebral pathology, psychiatric symptoms, cerebral lesion.
Summary. Knowledge of symptoms of appropriate brain areas lesion helps to differ
psychiatric and neurological disorders. The objective of our work was to find out the situation
in scientific research about mental disorder relation to brain lesion location and to except
the location of lesions, which are most complicated in differential diagnosis. We discussed
the relation of most important mental disorders to brain lesion location. The study of discrete
organic cerebral lesions resulting in clearly definable psychiatric disorders may provide an
understanding of the underlying pathophysiological basis of these disorders. Different
nervous functions need the integrational work of various brain areas. The regions differ
from each other by the importance of playing part in corresponding functions. The differential
problems appear because various structural brain lesions provide symptoms, similar to
mental disorder symptoms. The development of mental disorders and lesion location questions are very urgent. While analyzing the location of lesion, it is important to motivate the
theories of development of schizophrenia, organic depression, emotional lability and other
disorders.
The mass of the brain makes 2 percent of total
mass of human body. The brain uses 20 percent of
oxygen required for whole body. The brain gets 20
percent of blood output, provided by human heart. This
happens because human brain is controlling whole
body’s functions and behavior (1).
Different nervous functions need the integrational
work of various brain areas. The regions differ from
each other by the importance of playing part in corresponding functions. Even very difficult cognitive functions have their localization in appropriate areas of the
brain. Although the cerebral cortex is critically important, many other brain areas are also involved in higher
cognitive functions (2).
The study of discrete organic cerebral lesions resulting in clearly definable psychiatric disorders may
provide an understanding of the underlying pathophysiological basis of these disorders (9). Knowledge of
symptoms of appropriate brain areas lesion helps to
differ psychiatric (functional) and neurological (organic)
disorders. The major focus of research is on the temporal cortex; its lesion leads to auditory hallucinations,
delusions, and thought disorders (3, 27, 29). Even
though the scientists have done a lot of research work
in neuropsychological branch, it is still important to go
further into the understanding of some pathological
states dependence on the lesion location. However,
the relation between lesion location and psychiatric
illness, for example after stoke, remains unclear (4,
7). Does the post-stroke depression, emotional lability
development depend on localization of lesion? The
depression development association with cerebral pathology in multiple sclerosis is still not understood (5).
Even with the advance of new technologies such as
enhanced structural imaging (computed tomographicCT or magnetic resonance-MRI-imaging,), functional
imaging (positron emission tomographic-PET, single
photon emission computed tomographic-SPECT-imaging), questions regarding the damage of which brain
regions can result in well-defined psychiatric syndromes, are still not totally answered (6). The scientists pay a lot of attention to research of schizophrenia
etiology.
The asymmetry and laterality of the brain are very
important features while discussing the mental disorders’ relation to the brain lesion location (2, 9). The dominant hemisphere is the one to express language. The
left hemisphere is dominant in 96 percent of right-handed
Correspondence to D. Gudienė, Clinic of Psychiatry, Kaunas University of Medicine Hospital, Eivenių 2,
3007 Kaunas, Lithuania. E-mail: devika@centras. lt
Mental disorders and their relation to brain lesion location: diagnostical problems
persons and approximately 70 percent of left-handed
persons. In addition to language ability, the left hemisphere has been described as being the rational half of
the brain, concerned with analytic, sequencing, abstracting and logistical abilities. The right hemisphere is thought
to be more involved with perceptual, visual-spatial, artistic, musical and synthetic cortical activity. (1, 3)
The cerebral cortex contains approximately 70
percent of the neurons in the CNS. Because of this,
the cerebral cortex has been the main focus of many
psychiatric researches and theories (3). The cerebral
cortex receives direct or indirect afferent input from
almost every other area of brain (2). The cerebral
cortex anatomically can be divided into four lobes: frontal, which is 32.5 percent of whole cortex, temporal
(25.3 percent), parietal (21.5 percent) and occipital
(12 percent) (1-3). Dividing cerebral cortex by modality produces motor, sensory and association areas.
There are three major areas of supramodal association cortex: prefrontal, involved in cognitive planning
and motor activity, parietal-temporal-occipital, involved
in sensory evaluation and language, limbic, involved in
memory and emotion (2, 3, 27).
Major behavioral and psychological symptoms of
cortical injury are described in Table 1. In general,
frontal cortex is involved in motor behavior, expressive language, ability to concentrate and attend, reasoning and thinking and orientation in time, place and
person (2, 3). The scientists have made the conclusion, that ability to concentrate depends from the functioning of the anterior part of gyrus cinguli, which is in
right frontal lobe (8). The prefrontal cortex is involved
in planing of movements and evaluation of sensory
information (1-3).
Two general patterns of symptoms have been related to two different frontal lesions: dorsolateral convexity syndrome and orbitomedial syndrome. The dorsolateral convexity syndrome is described as apathy,
decreased drive, poor grooming, psychomotor retardation, decreased attention, and if dominant hemisphere is affected, aphasia. This syndrome is somewhat similar to so-called negative-symptom schizophrenia. Evidence from brain imaging techniques has
suggested this area of cortex as a potential lesion site
in a subgroup of patients with schizophrenia. Lesion
of orbitomedial frontal cortex results in withdrawal,
fearfulness, lability of mood, explosiveness, loss of inhibitions and occasional violent outbursts. Some of these
patients seem similar to patients with severe bipolar
illness (1, 3, 9).
The primary functions of temporal cortex include
language, memory and emotion. Because lesion of this
MEDICINA (2003) Vol. 39, No. 2 - http://medicina.kmu.lt
115
area leads to symptoms similar to hallucinations, delusions, mood disturbances, this area has received particular attention in psychiatric research. Lesions of the
dominant temporal lobe lead to euphoria, auditory hallucinations, delusions, thought disorders, decreased
ability to learn new material and poor verbal comprehension. Lesion of nondominant temporal lobe leads
to dysphoria, irritability and cognitive deficits (1-3, 9,
27). Scientists are also interested in frontotemporal
dementia, which is difficult to identify because its major
symptoms imitate non-organic psychiatric disorders
including mania, obsessive-compulsive disorder, schizophrenia, depression or personality disorder (34).
The parietal cortex has associational cortices for
visual, tactile and auditory input. The left lobe has a
preferential role in verbal processing and the right lobe
has a greater role in verbal processing (2, 3).
Gerstmann’s syndrome has been attributed to lesion
for the dominant parietal lobe and includes agraphia,
calculation difficulties, right-left disorientation and finger agnosia. Two symptoms of nondominant parietal
lesion are denial of illness (anosognosia) and neglect
of the left side. Clinically, a person with a right-sided
stroke may deny that he has paralyzed left arm and
also may completely ignore the left side of his body
(e.g., not washing it) (1, 3, 31).
The occipital lobe plays important part in vision. Total destruction of the occipital cortex results in cortical
blindness. Subtler dysfunction can result in distortion of
images, and loss of depth perception. Some of these
symptoms may be similar to those seen in psychiatric
conditions and may cause the clinician to miss the diagnosis of a neurologic disorder of the occipital lobes.
Anton’s syndrome is associated with bilateral occlusion
of the posterior cerebral arteries, resulting in cortical
blindness and denial of blindness (1, 3).
Frontal, parietal and temporal lobes are involved in
the reception and production of language. Patients with
frontal nondominant lesion are not able to inflect their
speech with affect (1, 3).
Limbic system is associated with emotions, sex
drive, eating behavior, violence, memory and motivation. The hippocampus is thought to be involved in
memory and motivation. The limbic system and
amygdala are mostly connected with emotions. Animal experiments showed, that stimulation of amygdala
provokes fear. Lesion of the amygdala and anterior
temporal lobes has been clinically correlated with symptoms similar to schizophrenia, depression and mania
(1-3, 9).
The basal ganglia are involved in number of cerebral disorders, including psychosis, depression and
116
Devika Gudienė, Benjaminas Burba
Table 1. Major behavioral and psychological symptoms of cortical injury
Lobe
Functions
Disfunctions
Frontal
Motor, sensory and emotional brain areas
Speech (dominant hemisphere)
Important for personality, memory,
concentration, judgement, abstract
thinking ant other higher mental
funcions
· Frontal lobe syndrome:
uninhibited, inappropriate behavior,
lability and irritability,
depression and flat affect,
lack of motivation,
memory deficit, attention difficulties,
other cognitive deficits
· Affective will disorder: apathetic-akinetinisabulic syndrome
· Aphasia (dominant hemisphere)
· Peculiar facetious sense of humor (Witzelsucht)
Temporal
Memory (especially hyppocampus )
Sexual and agressive behavior
Interpretation of gustatory and
olfactory sensations
Major part of limbic system
· Dominant hemisphere:
euphoria,
auditory hallucinations, illusions
tought disorders,
reduced capability to memorize new material,
weaker verbal comprehension, afazija,
memory impairement
· Nondominant hemisphere:
dysphoria,
troubles in controlling sexual and agressive
behavior,
impairment of other cognitive functions
Parietal
Receives and identifies sensory information
from tactile receptors
· Left hemisphere is important for verbal
processing
· Right hemisphere is important for
visual-spatial processing
Praxes
· Dominant hemisphere:
alexia, agraphia,
ideokinetic ir kinesthetc apraxias,
dyscalculia,
astereognosis
right-left disorientation
· Nondominant hemisphere:
impaired spatial abilities,
denial of illness (anosognosia),
inability to recognize body parts (autopagnosia)
apraxia,
astereognosis,
left spatial neglect
Occipital
Visual memory
Interpretation of visual images
Disturbed spatial orientation (metamorphopsia)
Visual illusions
Visual hallucinations
Blindness
Symptoms may simulate hysteria
Adopted from: Kėvelaitis E, Illert M, Hultborn H. Žmogaus fiziologija (Human Physiology). Kaunas; 1999; Avižonienė I, Barkauskas
E, Bičkuvienė I. Nervų ligos (Neural diseases). Vilnius; 1996; Kaplan HI, Sadock BJ. Clinical Psychiatry. Baltimore; 1988.
dementia. The major clinically observed disorders of
basal ganglia are movement, thought processes disorders, affect and cognition disorders. Basal ganglia disorders are most associated with symptoms of psychosis. Untreated schizophrenic patients show many subtle
movement disorders that imply an involvement of the
basal ganglia (2, 3). The scientists say that the functional consequences of cerebrovascular disease may
be the causal pathway by which basal ganglia lesions
are associated with depressive symptomatology (10).
MEDICINA (2003) Vol. 39, No. 2 - http://medicina.kmu.lt
Mental disorders and their relation to brain lesion location: diagnostical problems
The hypothalamus is involved in appetite and sexual
regulation. The destruction of lateral hypothalamus
results in anorexia and starvation (1-3, 9, 39).
Although we know a lot about thalamus functions,
the scientists are doing new researches. Pervasive
retrograde amnesia without anterograde memory impairment has rarely been described as a consequence
of circumscribed brain damage. Scientists reported this
phenomenon in right-handed man in association with
the extension in the right thalamus of a previously bilateral thalamic lesion. This case added to the growing body evidence to suggest that world knowledge
pertaining to people and events is stored or accessed
similarly to autobiographical information and differently
from other types of more general factual knowledge.
The scientists hypothesized that the right mediodorsal
thalamic nucleus and immediately surrounding regions
comprise the central processing mechanism as responsible for inducing and coordinating the recall of these
sorts of cortically stored memory (11, 28). Anosognosia
had a significantly higher frequency of right hemisphere
lesions, primarily involving the thalamus, basal ganglia
and temporoparietal junction (12, 28, 31).
Although the medial geniculate body is a wellknown integration center for the central auditory pathways, auditory symptoms caused by its damage have
not been described. Scientists reported the appearance of the auditory illusions of hyperacusis to the
patients without previous psychiatric or epileptic illness after a hemorrhagic infarction located mainly in
the right medial geniculate body (13).
The major focus of research is on the depressive
symptoms development in relation with the localization of lesion. Depression, which is starting after the
stroke, is frequent subject of discussion. The conclusion of the research work on after stroke depression
relation with the lesion location, made in UK (1998),
was that depression is significantly associated with
larger lesions involving the right cerebral hemisphere.
The importance of depression as a consequence of
stroke has been clarified by the studies in this area.
According to the studies results, the emotional lability
development is also related with the stroke. But, this
contradicts the psychiatric hypothesis, that lesion of
the left hemisphere more often results in depression.
However, wide confidence intervals support the possibility that significant results may be due to chance.
Other scientists made a research work, but reports by
other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere,
were not supported. Neither there was the evidence
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117
of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral
hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions (14).
Although, there were made a lot of studies, proving
the correctness of above-mentioned hypothesis, still
there are works, which results allow to doubt, if the
lesion lateralization is so important for the onset of
depression. A systematic review of these studies is
now needed if a consensus is to be reached (4).
Depression and emotional lability is frequent after
stroke condition (4). But exact location of lesion was
unknown for a long time. There was a scientific study
made in Korea (2000). The aims of this study were to
determine the frequency of emotional lability following first ever stroke, and to find out the relation of the
location of stroke with post stroke depression and
emotional lability. Emotional lability was present in 18
percent of patients (15).
The frequency was higher in women than in men
and in ischemic rather than hemorrhagic stroke. The
presence of post-stroke emotional lability and especially post-stroke depression was related to lesion of
anterior cortex part (16). The prevalence of post-stroke
depression was 75% and post-stroke emotional lability -100% in location in frontal lobe of anterior cerebral artery territory. When the lesion was in temporal
lobe, half of patients had depression, but no one, same
as when the lesion was located in occipital lobe, had
any emotional lability. When the lesion is in middle
cerebral artery territory and in thalamus the prevalence of both states is nearly equal. The prevalence of
emotional lability was 22 percent, when the lesion was
in cerebellum, but there were no post-stroke depression cases (37). According to these results, the scientists made a conclusion, that the development of poststroke depression and post-stroke emotional lability is
strongly influenced by lesion location. This is mostly
related to the frontal/temporal lobe-basal ganglia-ventral brainstem circuitry. Post-stroke emotional lability
is more closely related to lenticulocapsular strokes than
is post stroke depression. (16) Other study declares
that emotional lability occurs independently of post
stroke depression (15).
The relationship between depression and the
alterations in the frontal and temporal lobes of the right
hemisphere supports, on the contrary, the causative
role of organic brain damage. The lack of any
significant association between symptoms of anxiety
and either MRI abnormalities or clinical variables led
to the opinion that anxiety is a reactive response to the
psychosocial pressure put on the patients (35).
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Devika Gudienė, Benjaminas Burba
Recent studies indicate a biological origin of poststroke depressive disorders. Only a few studies of poststroke depression report detailed neuropsychological
assessments (10). The was study made in Germany
(1999), which analyzed lesion configuration in patients
in the post-acute stage after first single unilateral
stroke, who suffered from depressive disorders. Patients with left hemisphere strokes exhibited a major
depression and patients with right hemisphere infarcts
– a minor depression. The most prominent lesions were
found in frontal lobe. Type and severity of depression
were not related to the severity of neurological symptoms. For both major and minor depression the maximal overlap of lesions was found in subcortical areas,
including parts of the caudate nucleus, posterior parts
of the putamen, and the deep white matter. The findings supported the theory that post stroke depression
was related to the dysfunction of (cortico-) striatopallido-thalamic-cortical projections that modulate
cortico-thalamo-cortical loop systems. (7)
Using patients with a single left- or right-hemisphere
stroke, the scientists in 1999 in USA investigated the
distinction between major and minor depression after
stroke. They find out, that minor depression was associated with younger age, left-hemisphere lesion location, and more caudal hemisphere lesions. But the
question about the significance of damage in left-hemisphere posterior portions of the brain for the development of minor depression after stroke is still left for
discussion (17).
This consecutive multiple case study, done in
Canada in 1999, was designed to determine whether
cortical lesion sites can predict occurrence of mood
or psychomotor disorders in adults and children. However, it is not clear how psychomotor status fits into
this picture, or whether children respond to the same
lesions in a similar manner. They analyzed cases of
school-aged children and adult patients with focal unilateral cortical lesions. The study was based on hypothesis, that left hemisphere lesions result more often than right ones in depression, and that the inverse
occurs in mania. The findings of the study supported
the neuropsychiatric approach to mood and psychomotor disorder in children and adults. Patients with
mania and/or psychomotor agitation had predominantly
right hemisphere lesions. Adult and children patients
with depression and/or psychomotor lethargy had predominantly left hemisphere lesions (18).
In a study of patients with focal epilepsy, the hypothesis was explored that different measurements of
psychopathology were related to specific distribution
of cerebral perfusion. The results do not support the
notion that lateralized epileptogenic lesions are associated with different levels of depression, obsession,
or personality traits. They support the view that certain psychopathological symptom patterns are related
to specific regional dysfunctions depending on the laterality of a hemispheric lesion (19). Cases of bipolar
disorder subsequent to a mild head injury were reported. Review of the literature indicates that these
are rare outcomes (32).
The concept of a conversion disorder (such as) has
always been controversial (20). Although the diagnosis
is recognized by current psychiatric taxonomies, many
physicians still regard such disorders either as feigned
or as failure to find the responsible organic cause for
the patient’s symptoms. That’s why thorough analysis
of hysterical paralysis was made. The patients had no
organic disease or structural lesion. Psychological
trauma was associated with the onset. They reported
patients with left-sided paralysis (and without somatosensory loss). The attempt to move the paralyzed leg failed
to activate right primary motor cortex. Instead, the right
orbito-frontal and right anterior cingulate cortex was
significantly activated. Based on this, scientists suggested
that these two areas inhibited prefrontal (willed) effects
on the right primary motor cortex when patients tried to
move their left leg (21). These results prove, that not
only the lesion localization is important, but appropriate
brain areas activity’s changes also play significant part
in the development of mental illness.
According to Swiss scientists, who revealed with
single photon emission computerized tomography using (99m)Tc-ECD a consistent decrease of regional
cerebral blood flow in the thalamus and basal ganglia
contralateral to the hysterical deficit. Independent parametric mapping and principal component statistical
analyses converged to show that such subcortical asymmetries were present in each subject. Importantly,
contralateral basal ganglia and thalamic hypoactivation
resolved after recovery. These results suggest that
hysterical conversion deficits may entail a functional
disorder in striato-thalamo-cortical circuits controlling
sensorimotor function and voluntary motor behavior.
Basal ganglia, especially the caudate nucleus, might
be particularly well-situated to modulate motor processes based on emotional and situational cues from
the limbic system. Remarkably, the same subcortical
premotor circuits are also involved in unilateral motor
neglect after organic neurological damage, where voluntary limb use may fail despite a lack of true paralysis and intact primary sensorimotor pathways. These
findings provide novel constraints for a modern psychobiological theory of hysteria (36).
MEDICINA (2003) Vol. 39, No. 2 - http://medicina.kmu.lt
Mental disorders and their relation to brain lesion location: diagnostical problems
We already know relation of some mental illnesses
with lesion location, but many of them have to be studded more. Swedish scientists decided to analyze the
topographical location of obsessive-compulsive disorder. The results appealed to capsulotomy effect. Stereotactic capsulotomy by means of thermo lesions may
provide symptomatic relief for patients with otherwise
therapy refractory “malignant” obsessive-compulsive
disorder. In patients, who fulfilled criteria for good
postoperative outcome, all lesion sites overlapped covering a small area within the right anterior limb of the
internal capsule. Analyzing this method and results,
rather definite lesion location, which can “provide“
obsessive-compulsive disorder, was found (22, 38).
Investigations into the neuropathology of schizophrenia have increasingly altered the perception of the
illness. Early studies focused on finding consistent and
discrete areas of cortical pathology in the brain material of schizophrenic patients. After nearly a half century of study, little evidence emerged from a great body
of data suggesting any consistent, discrete neuropathologic finding associated with this illness. This lack of
evidence led to obvious frustration on the part of researchers and movement within the psychiatric community towards significantly less brain-based theories
of the genesis of schizophrenia. With the advance of
new technologies such as enhanced structural imaging (CT, MRI), functional imaging (PET, SPECT), and
better neuropathologic methods, the focus of schizophrenia research has again turned towards the brain.
Ultimately, hypotheses regarding the cause of schizophrenia will be proved or disproved on neuropathologic evidence (30). Few, if any, modern schizophrenia researchers would make the argument that there
is a single, consistent neuropathologic lesion that is
responsible for the entire illness of schizophrenia. Current theories tend to interpret the wide variety of neuropathologic changes in this illness as evidence of disturbed nervous system maturation, either acquired or
inherent, or perhaps as a response to damage with
aberrant neuronal regeneration. Evidence for a
neurodegenerative disorder has not proved to be compelling. Furthermore, these theories emphasize dysfunction of elements of distributed neuronal systems,
including subcortical systems, not discrete “lesions.”
Despite the risks, this approach to investigation promises to offer more than just information pertinent to
schizophrenia research; it offers insights into the
mechanisms of behavior as a product of integrated
brain function (23, 33).
Schizophrenia has been the subject of intensive
neuropsychological, neuroradiological, neuropathologiMEDICINA (2003) Vol. 39, No. 2 - http://medicina.kmu.lt
119
cal, and neurochemical investigations. The most consistent and reproducible result from all this effort has
been the demonstration of a mild degree of enlargement of the cerebral ventricles. The existence of this
finding is no longer a subject of controversy, and it
clearly occurs independently of psychiatric treatment
and chronicity of disease. This finding represents the
strongest evidence to date that a structural lesion of
the central nervous system underlies schizophrenia.
The localization of the lesion responsible for ventricular enlargement and for the clinical findings in schizophrenia is not as clear.
With genetic and neurochemical findings pointing
to a biological etiology, considerable effort has been
devoted to finding direct evidence of brain abnormality in schizophrenia. Schizophrenia is characterized by
minor structural abnormality, which, in the case of lateral ventricular enlargement, may be better understood
as a risk factor than a causative lesion. The functional
imaging findings are not transparent but suggest that
as a disorder schizophrenia shows complex alterations
in regional patterns of activity rather than any simple
deficit (as for example: in prefrontal function) (25).
Neurodevelopmental models of schizophrenia imply
that a more severe early brain lesion may produce
earlier onset of psychotic symptoms (24, 33). The
medial temporal lobes have been proposed as possible
locations for such a lesion. The authors tested this
hypothesis in a group of children and adolescents with
childhood-onset schizophrenia who had severe, chronic
symptoms and who were refractory to treatment with
typical neuroleptics. Patients with childhood-onset
schizophrenia had significantly smaller cerebral
volumes. With no adjustment for brain volume, no
diagnostic differences were observed for any temporal
lobe structure. Unexpectedly, with adjustment for total
cerebral volume, larger volumes of the superior
temporal gyrus and its posterior segment and a trend
toward larger temporal lobe volume emerged for the
patients with schizophrenia. These patients lacked the
normal (right-greater-than-left) hippocampal
asymmetry. These findings do not indicate a more
severe medial temporal lobe lesion as the basis of very
early onset schizophrenia (26).
Rather similar results where found by many groups
of researchers. Several groups, using both in vivo
neuroimaging and postmortem anatomic techniques,
have independently identified pathologic alterations in
the anteromedial temporal lobe, particularly in the
hippocampus. The details and etiology of temporal
lobe-hippocampal pathologic states remain to be elucidated (24).
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Devika Gudienė, Benjaminas Burba
Conclisions
We discussed relation of the most important mental
disorders to the location of brain lesion. Different
nervous functions need the integrational work of
various brain areas. The regions differ from each other
by the importance of playing part in corresponding
functions. The development of mental disorders and
lesion location questions are talking points now. The
differential problems appear, because various
structural brain lesions provide symptoms, similar to
mental disorder’s symptoms. Since lesion of temporal
cortex leads to symptoms similar to hallucinations,
delusions, mood disturbances, this area has received
particular attention in psychiatric research. Lesion of
frontal lobe results in dorsolateral convexity syndrome
and it is somewhat similar to so-called negative-symp-
tom schizophrenia. Lesion of orbitomedial frontal cortex results in orbitomedial syndrome and some of these
patients seem similar to patients with severe bipolar
illness. Lesion of the amygdala and anterior temporal
lobes have been clinically correlated with syndromes,
are still not totally answered. The psychiatric hypothesis, that lesion of the left hemisphere and of anterior
part of the brain more often results depression coming
is still question of discussion. Modern schizophrenia
theories emphasize dysfunction of elements of distributed neuronal systems, not discrete “lesions.” Scientists’ findings represent the strongest evidence to date
that a structural lesion of the central nervous system
underlies schizophrenia, but more exact location of brain
lesion, which results in onset of schizophrenia, is still
the question of the day scientific discussions.
Psichikos sutrikimų priklausomumas nuo galvos smegenų
pažeidimo vietos. Diagnozavimo sunkumai
Devika Gudienė, Benjaminas Burba
Kauno medicinos universiteto klinikų Psichiatrijos klinika
Raktažodžiai: organinė galvos smegenų patologija, psichikos sutrikimų simptomai,galvos smegenų pažeidimas.
Santrauka. Žinant atitinkamos galvos smegenų dalies pažeidimo simptomus, galima lengviau diferencijuoti
psichiatrinius ir neurologinius pažeidimus. Darbo tikslas – išnagrinėti, kokių yra mokslinių tyrimų duomenų
tiriant psichikos sutrikimų priklausomumą nuo galvos smegenų pažeidimo vietos. Taip pat išskirti lokalizaciją tų
pažeidimų, kurie sukelia sunkiausiai diferencijuojamus psichikos sutrikimus. Išanalizuotas svarbiausių psichikos
sutrikimų pasireiškimas priklausomai nuo galvos smegenų pažeidimo vietos. Tiriant atskirus organinius galvos
smegenų pažeidimus, kurie sukelia aiškių psichikos sutrikimų, galima nuodugniau ištirti šių sutrikimų patofiziologinį
pagrindą. Įvairioms nervų sistemos funkcijoms reikia daugelio smegenų sričių integracinės veiklos, bet kai
kurios sritys dalyvauja vienose funkcijose labiau negu kitose. Diferencinės diagnostikos sunkumus sudaro tai,
kad struktūriniai galvos smegenų pažeidimai sukelia simptomų, panašių į psichikos ligų būsenas. Dabar yra
aktualūs psichikos sutrikimų pasireiškimo ir pažeidimo vietos sąsajos klausimai. Pažeidimų būdingos lokalizacijos
studijavimas yra aktualus šizofrenijos, organinės depresijos, emocinio labilumo ir kitų būklių pasireiškimo teorijoms
pagrįsti.
Adresas susirašinėjimui: D. Gudienė, KMUK Psichiatrijos klinika, Eivenių 2, 3007 Kaunas
El. paštas: devika@centras. lt
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Received 8 September 2002, accepted 20 January 2003
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