Temporal horn enlargement is present in schizophrenia and bipolar disorder

doi:10.1016/S0006-3223(98)00105-X

Biological Psychiatry

Volume 44, Issue 6, 15 September 1998, Pages 418-422

https://doi.org/10.1016/S0006-3223(98)00105-X Get rights and content

Abstract

Background: Ventricular enlargement and temporal lobe volume deficits have been demonstrated in patients with affective disorder as well as those with schizophrenia. This study compares quantitative measures of temporal lobe, hemispheric, and ventricular volumes in a group of patients with chronic schizophrenia and bipolar disorder and seeks to determine if the groups can be differentiated on the basis of measured brain abnormalities.

Methods: A series of coronal magnetic resonance imaging sections were acquired and analyzed for each of 22 patients with chronic schizophrenia, 14 patients with bipolar disorder, and 15 community volunteers. Eleven regions of interest for each brain were defined, which included temporal lobe, superior temporal gyrus, hemisphere, lateral ventricle, third ventricle, and temporal horn measures. Tissue measures were obtained by tracing, and cerebrospinal fluid measures were obtained by fluid–tissue thresholding using specialized computer software.

Results: Both patient groups had significantly larger temporal horn volumes in comparison with the control group both before and after correction for intracranial volume. The two patient groups did not differ from each other or controls on any other tissue or fluid measure.

Conclusions: This study confirms the finding of increased temporal horn volume in patients with schizophrenia and suggests that this structural abnormality does not differentiate the structural neuropathology of schizophrenia from that of bipolar disorder.

Introduction

Computed tomographic (CT) and magnetic resonance imaging (MRI) investigations have shown that the brains of schizophrenic patients as a group have larger lateral ventricles as well as medial temporal lobe volume deficits in comparison with normals Raz and Raz 1990, Barta et al 1990, Bogerts et al 1990, DeLisi et al 1988, Suddath et al 1989. Some studies have failed to confirm findings of reduced medial temporal lobe volumes DeLisi et al 1991, Kelsoe et al 1988, Zipursky et al 1994. The ventricular and sulcal enlargement seen in patients with schizophrenia has also been reported in patients with affective illness Andreasen et al 1990, Elkis et al 1995, Jeste et al 1988, Nasrallah et al 1989, Raz and Raz 1990. A number of recent studies have demonstrated reduced temporal lobe volumes in the affective population Altshuler et al 1990, Hauser et al 1989, Johnstone et al 1989, Swayze et al 1992.

This study was undertaken to investigate structural brain abnormalities in a group of patients with chronic schizophrenia and to determine whether they could be distinguished from the brain abnormalities found in a comparison group of bipolar subjects. Quantitative measures of temporal lobe and hemispheric structures as well as ventricular volumes were assessed from a series of coronal MRI scans. We predicted that both patient groups would have larger ventricular volumes and that deficits in temporal lobe volumes would be present only in the schizophrenia group.

Section snippets

Methods and materials

Twenty-two patients meeting DSM-III-R criteria for chronic schizophrenia were compared to a control group of 15 community volunteers, comparable to the schizophrenia group on age, sex, and education, and a group of 14 patients meeting DSM-III-R criteria for bipolar disorder (Table 1). All subjects were Caucasian except for 1 man with schizophrenia and 1 male control subject, both of whom were of Asian non-Oriental race. Subjects were excluded if they had a history of major medical illness, head

Results

Tissue and CSF volumes were significantly correlated with intracranial volume (Table 2). After correcting these measures for intracranial volume there were no significant correlations between age and any of the brain measures. All CSF and tissue values are reported in Table 2.

The schizophrenia group had larger temporal horn values than the controls both before and after correction for intracranial volume (p ≤ .01 and p ≤ .05, respectively). Third ventricle volume was also greater in the

Discussion

A number of postmortem neuropathological studies of the brains of patients with schizophrenia have demonstrated volume reductions in medial temporal lobe structures including the hippocampus, parahippocampus, and amygdala formations. Many of these studies have associated temporal horn enlargement with volume reductions in these limbic structures. Bogerts et al 1985, Bogerts et al 1990, Brown et al 1986, Crow et al 1989, Falkai et al 1988, Jeste and Lohr 1989. This study confirms the finding of

Acknowledgements

This paper was supported in part by a grant from the Stanley Foundation.

The authors would like to thank Mr. Edmond Chong and Ms. Evelyn Lambe for their assistance with image processing. We also wish to acknowledge the assistance of Allan L. Reiss in making Brain Image (National Institute of Child Health and Human Development, Human Brain Project, HD 31715) available to us.

This work was presented at the International Congress on Schizophrenia Research at Warm Springs, Virgina, in April 1995.

References (28)

B Bogerts et al.
Post-mortem volume measurements of limbic system and basal ganglia structures in chronic schizophrenicsInitial results from a new brain collection
Schizophr Res
(1990)
L.E DeLisi et al.
Brain morphology in first-episode schizophrenic-like psychotic patientsA quantitative magnetic resonance imaging study
Biol Psychiatry
(1991)
P Falkai et al.
Limbic pathology in schizophreniaThe entorhinal region—A morphometric study
Biol Psychiatry
(1988)
G.D Pearlson et al.
Medial and temporal gyral volumes and cerebral asymmetry in schizophrenia versus bipolar disorder
Biol Psychiatry
(1997)
V.W Swayze et al.
Subcortical and temporal structures in affective disorder and schizophreniaA magnetic resonance imaging study
Biol Psychiatry
(1992)
R.B Zipursky et al.
Volumetric MRI assessment of temporal lobe structures in schizophrenia
Biol Psychiatry
(1994)
L.L Altshuler et al.
The hippocampus and parahippocampus in schizophrenic, suicide, and control brains
Arch Gen Psychiatry
(1990)
N.C Andreasen et al.
Ventricular abnormalities in affective disorder—Clinical and demographic correlates
Am J Psychiatry
(1990)
P.E Barta et al.
Auditory hallucinations and smaller superior temporal gyral volume in schizophrenia
Am J Psychiatry
(1990)
B Bogerts et al.
Basal ganglia and limbic system pathology in schizophrenia
Arch Gen Psychiatry
(1985)

R Brown et al.

Postmortem evidence of structural brain changes in schizophreniaDifferences in brain weight, temporal horn area and parahippocampal gyrus compared with affective disorder

Arch Gen Psychiatry

(1986)

T.J Crow et al.

Schizophrenia as an anomaly of development of cerebral asymmetryA postmortem study and a proposal concerning the genetic basis of the disease

Arch Gen Psychiatry

(1989)

L.E DeLisi et al.

Perinatal complications and reduced size of brain limbic structures in familial schizophrenia

Schizophr Bull

(1988)

H Elkis et al.

Meta-analyses of studies of ventricular enlargement and cortical sulcal prominence in mood disordersComparison with controls or patients with schizophrenia

Arch Gen Psychiatry

(1995)

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Original ArticlesTemporal horn enlargement is present in schizophrenia and bipolar disorder

Abstract

Introduction

Section snippets

Methods and materials

Results

Discussion

Acknowledgements

Schizophr Res

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

The hippocampus and parahippocampus in schizophrenic, suicide, and control brains

Arch Gen Psychiatry

Ventricular abnormalities in affective disorder—Clinical and demographic correlates

Am J Psychiatry

Auditory hallucinations and smaller superior temporal gyral volume in schizophrenia

Am J Psychiatry

Basal ganglia and limbic system pathology in schizophrenia

Arch Gen Psychiatry

Postmortem evidence of structural brain changes in schizophreniaDifferences in brain weight, temporal horn area and parahippocampal gyrus compared with affective disorder

Arch Gen Psychiatry

Schizophrenia as an anomaly of development of cerebral asymmetryA postmortem study and a proposal concerning the genetic basis of the disease

Arch Gen Psychiatry

Perinatal complications and reduced size of brain limbic structures in familial schizophrenia

Schizophr Bull

Meta-analyses of studies of ventricular enlargement and cortical sulcal prominence in mood disordersComparison with controls or patients with schizophrenia

Arch Gen Psychiatry

Original Articles
Temporal horn enlargement is present in schizophrenia and bipolar disorder