Saturday, 12 June 2004
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Friday, 11 December 2009
Brain Scan PTSD
Some combat veterans' difficulty returning to civilian life may be in part connected to smaller brain volume, researchers found.
Post-traumatic stress disorder (PTSD) after fighting in a war zone was strongly linked to smaller cortical volumes in four areas of the brain involved in identifying objects and words and putting them in context, according to a study led by Steven H. Woodward, PhD, of the National Center for PTSD at the VA Palo Alto Health Care System in California.
"Compromise of these regions may result in difficulty in relearning pretrauma schemata for interpreting the civilian physical and social environments," the investigators wrote in the December Archives of General Psychiatry.
Woodward's group used new advances in the structural analysis of MRI to revisit cortical volume in a group of 99 Vietnam and Gulf War veterans they had previously studied.
Half the participants met criteria for current PTSD (37 Vietnam and 13 Gulf War veterans) as a result of experiencing military trauma.
PTSD was associated with significantly lower total cortical volume adjusted for age (350,744 mm3 versus 368,896 mm3, P<0.01). The link was strengthened by adjustment for stature and volume of white matter in the brain (P<0.001).
Alcohol abuse or dependence, past or present, also tended to be correlated with lower total cortical volume (P=0.06) but there was no significant interaction with PTSD.
Cortical thickness as a weighted mean over the whole brain was likewise significantly lower among veterans with PTSD (2.384 versus 2.428 mm, P=0.03).
All individual areas of the brain that were linked through volume to PTSD showed inverse associations as well. After adjustment for stature and cerebral white matter volume, those that remained significant were:
* Parahippocampal gyrus (P<0.001)
* Superior temporal cortex (P<0.001)
* Lateral division of the orbital frontal cortex (P=0.001)
* Pars orbitalis of the inferior frontal gyrus (P=0.002)
There were no multivariate associations with PTSD for thickness of individual areas of the brain, but planned comparisons found significantly thinner rostral (P=0.007), caudal (P=0.03), and superior temporal cortex (P=0.04) divisions in veterans with PTSD.
Total cortical area also tended to be smaller in association with PTSD (P=0.06), but the superior temporal cortex was the only individual area for which the comparison was significant (P=0.02).
Compromised structure in the parahippocampal, and orbital frontal areas among individuals with PTSD suggested problems with facilitated object identification, Woodward's group wrote.
Recent studies have shown that the parahippocampal gyrus works with the hippocampus to determine how objects relate to each other within space and "in contextualization more generally," they added.
They also noted that "misperception of safe versus threatening contexts has been proposed to contribute to PTSD."
The ventrolateral and orbital frontal cortex regions, which were seen to be smaller in PTSD-affected veterans, also play a role in identifying objects, with the whole system heavily interconnected. The superior temporal cortex has also been implicated in stimulus identification, the authors noted.
If structural and functional compromise to these areas hampers their plasticity, conditioning by trauma sustained during combat could continue to influence identification of words and objects after the return home, the researchers suggested.
As in prior studies in which PTSD has been linked to lower intelligence, scores in vocabulary and digit symbol substitution on the Wechsler Adult Intelligence Scale were significant predictors (P<0.001 and P=0.003, respectively).
Brain volume appeared to be a mediating factor between intelligence and the likelihood of PTSD (P=0.006 for cortical thickness and digit symbol substitution score, P=0.01 for total area and vocabulary score).
The researchers cautioned that their study was limited by predetermining which regions of the cortex to examine and by the greater use of psychotropic medications in the PTSD group than with other veterans (70% versus 10.6%), which could have an unknown impact on cortical structure.
The study was largely funded under a Department of Veterans Affairs/Department of Defense assistance agreement from the US Army Medical Research and Material Command administered through the VA. Additional support was provided by Swiss National Research Funds grants.
Primary source: Archives of General Psychiatry
Woodward SH, et al "Smaller global and regional cortical volume in combat-related posttraumatic stress disorder" Arch Gen Psychiatry 2009; 66: 1373-82.
Thursday, 12 November 2009
Symptoms of Brain Aneurysms (Ruptured/Unruptured)
Ruptured Cerebral Aneurysm Symptoms
Sometimes patients describing "the worst headache in my life" are actually experiencing one of the symptoms of brain aneurysms related to having a rupture. Other ruptured cerebral aneurysm symptoms include:
* Nausea and vomiting
* Stiff neck or neck pain
* Blurred vision or double vision
* Pain above and behind the eye
* Dilated pupils
* Sensitivity to light
* Loss of sensation
Unruptured Cerebral Aneurysm Symptoms
Before an aneurysm ruptures, patients often experience no symptoms of brain aneurysms. In about 40 percent of cases, people with unruptured aneurysms will experience some or all of the following cerebral aneurysm symptoms:
* Peripheral vision deficits
* Thinking or processing problems
* Speech complications
* Perceptual problems
* Sudden changes in behavior
* Loss of balance and coordination
* Decreased concentration
* Short-term memory difficulty
Because the symptoms of brain aneurysms can also be associated with other medical conditions, diagnostic neuroradiology is regularly used to identify both ruptured and unruptured brain aneurysms.
Diagnosis of Brain Aneurysms
Diagnosis of a ruptured cerebral aneurysm is commonly made by finding signs of subarachnoid hemorrhage on a CT scan (Computerized Tomography, sometimes called a CAT scan). The CT scan is a computerized test that rapidly X-rays the body in cross-sections, or slices, as the body is moved through a large, circular machine. If the CT scan is negative but a ruptured aneurysm is still suspected, a lumbar puncture is performed to detect blood in the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord.
To determine the exact location, size and shape of an aneurysm (ruptured or unruptured), neuroradiologists will use either cerebral angiography or tomographic angiography.
Cerebral angiography, the traditional method, involves introducing a catheter (small plastic tube) into an artery (usually in the leg) and steering it through the blood vessels of the body to the artery involved by the aneurysm. A special dye, called a contract agent, is injected into the patient's artery and its distribution is shown on X-ray projections. This method may not detect some aneurysms due to overlapping structures or spasm.
Computed Tomographic Angiography (CTA) is an alternative to the traditional method and can be performed without the need for arterial catheterization. This test combines a regular CT scan with a contrast dye injected into a vein. Once the dye is injected into a vein, it travels to the brain arteries, and images are created using a CT scan. These images show exactly how blood flows into the brain arteries.