Jocelyne S. Lapointe

CLINICAL SPECTRUM OF CONGENITAL OPTIC NERVE HVPOPLASIA: REVIEW OF 51 PATIENTS

Fifty‐one patients with congenital optic nerve hypoplasia (CONH) were reviewed. It was found tkat the risk of having an affected child is higher in an adolescent mother, and that maternal alcohol or drug abuse may be important factors. Frequently the disorder is associated with other neuropsychiatric handicaps, and with neuro‐endocrine abnormalities. The findings suggest that CONH probably is not a homogeneous group of disorders; some may be caused by primary failure of differentiation of the retinal ganglion cells, while others may be the product of an acquired transsynaptic degeneration of optic‐nerve fibres.

Developmental abnormalities of the hippocampus in First-Episode schizophrenia

BACKGROUND The human hippocampus becomes visible during the first trimester and folds to form the hippocampal fissure (HF) in the second trimester. The walls of this fissure fuse by 30 weeks, although small residual cavities can occur if development is disrupted. The primary purpose of this study was to determine if hippocampal fissures are evident in schizophrenia. A second goal was to assess the association between HF size and premorbid and clinical features of the illness. METHODS Magnetic resonance imaging scans were obtained on 33 patients with first-episode schizophrenia and 19 healthy volunteers. Hippocampal fissures were measured using semi-automated procedures, and hippocampi were manually traced. Birth history and premorbid functioning were assessed using maternal report. RESULTS Patients had a significantly larger mean HF volume and a nonsignificantly smaller hippocampal volume. Hippocampal fissure size was significantly associated with poor educational achievement and with anxiety-depression symptoms during the onset of illness. Smaller hippocampal size was associated with poor premorbid adjustment. CONCLUSIONS Larger HF size and an association between low educational achievement and enlarged HFs suggest abnormal neurodevelopment in schizophrenia. The association between HF size and anxiety-depression symptoms suggests that hippocampal abnormalities underlying HF dilatation may be a predisposing factor for increased stress sensitivity.

Regional cortical anatomy and clozapine response in refractory schizophrenia

Regional measures of cortical sulcal and ventricular enlargement on computed tomography scan were studied in a clinical sample of patients treated with clozapine. Cortical sulci were significantly enlarged in clozapine nonresponders compared to responders. The Clinical Global Impressions score at discharge was related to the size of the posterior frontal and lateral temporal sulci, with large sulci predicting a poorer response to clozapine treatment.

Computed tomography of a cerebellopontine angle lipoma.

In this report we document the clinical, radiologic, surgical, and pathologic features of a cerebellopontine angle (CPA) lipoma, including the CT visualization of the seventh and eighth cranial nerves passing through the middle of the lesion, a feature previously undescribed. Comparison is made with other reported CPA lipomas.

Cerebral infarction and regression of widespread aneurysms in Kawasaki's disease: case report.

The prevalence of Kawasakis disease has increased in the last decade and it is now recognized worldwide. Coronary aneurysms are an important complication often causing death. The widespread vascular changes which can occur are illustrated by a patient who presented with a cerebral infarct and who developed widespread aneurysmal disease which regressed.

The temporal lobes, reversed asymmetry and the genetics of schizophrenia

Mechanisms determining temporal lobe structural asymmetries may be involved in the pathogenesis of schizophrenia. To investigate the temporal lobes in familial schizophrenia, computed tomographic scans were obtained from 51 subjects (seven families). Enlargement of sylvian fissures and temporal lobe sulcal spaces was observed in family members with schizophrenia. The posterior one-third of the sylvian fissure was larger on the left side in subjects with schizophrenia, and larger on the right side in unaffected individuals. This disturbed pattern of posterior sylvian fissure asymmetry suggests that adjacent language regions may be affected in schizophrenia. An intermediate degree of disturbance in subjects who had schizophrenia-related illnesses or were obligate carriers suggests that genetic factors may be important determinants of temporal lobe asymmetries in familial schizophrenia.

Schizencephaly associated with psychosis

Schizencephaly is a rare disorder of brain development resulting in the formation of abnormal unilateral or bilateral clefts in the cerebral hemispheres. It is often accompanied by partial seizures, mental retardation, and hemiparesis. Two patients are described with clear psychotic symptoms with either unilateral or bilateral schizencephaly. The implications of the association between schizencephaly and psychosis in these patients for understanding the biology of the psychoses are discussed.

A comprehensive method of assessing routine CT scans in schizophrenia

Morphological brain abnormalities are common in schizophrenia, although the aetiological and clinical significance of these findings is largely unknown. Substantial between‐subject variability suggests that large samples are needed to study the full implications of brain pathomorphology. Computerized tomography (CT) is frequently used routinely in schizophrenia, and large numbers of scans are available for study. This article describes the development and statistical properties of a rapid and simple method of assessing CT scans. The CT Rating Scale for Schizophrenia (CTRSS) is minimally affected by variability in scanning procedures, is reliable, and accurately estimates area and volumetric measures of brain spaces. By promoting the comprehensive assessment of large numbers of routinely obtained scans, the CTRSS would allow the investigation of variables that may systematically affect results (e.g. gender and age) and variables with low prevalence. The CTRSS provides a useful adjunct to technologically more sophisticated methods of assessment such as magnetic resonance imaging (MRI).

Left cerebral hemiatrophy and schizophrenia-like psychosis in an adolescent

A previous report of cerebral hemiatrophy and schizophrenia added to the list of neurodevelopmental abnormalities associated with schizophrenia. In a new case, the birth history indicated perinatal hemorrhage and prematurity (30-31 weeks of gestation). CT and MR imaging showed reduction in left hemisphere size with ventricular enlargement and mild skull thickening. Loss of periventricular white matter was detected. Changes in skull thickness, size of air cells and volume of the cranial vault may be measurable correlates of putative developmental abnormalities in schizophrenia.

Obstetric complications and age-related changes in brain morphology in schizophrenia

Birth problems can lead to changes in brain morphology in the general population and an increased prevalence of both birth problems and altered brain morphology are found in patients with schizophrenia. The purpose of this study was to test the hypothesis that these two findings are related. Birth history and the size of ventricular and sulcal spaces from nine regions of the brain were assessed in 80 male subjects with schizophrenia. No differences were found between patients with and those without a history of birth problems for the size of any brain space; however, ventricular size increased significantly with age in patients who had no birth complications but not in patients with a history of birth problems. The size of cortical sulci increased with age in patients with and those without a history of birth problems. These results suggest that region-specific rates of change in size may identify clinically meaningful patients subgroups.