title: Stroke lesion in cortical neural circuits and post-stroke incidence of major depressive episode: a 4-month prospective study.
abstract: OBJECTIVE
  Little is known about the relevance of lesion in neural circuits reported to be associated with major depressive disorder. We investigated the association between lesion stroke size in the limbic-cortical-striatal-pallidal-thalamic (LCSPT) circuit and incidence of major depressive episode (MDE).
  
  
  METHODS
  We enrolled 68 patients with first-ever ischemic stroke and no history of major depressive disorder. Neurological and psychiatric examinations were performed at three time-points. We diagnosed major depressive episode, following DSM-IV criteria. Lesion location and volume were determined with magnetic resonance imaging, using a semi-automated method based on the Brodmann Cytoarchitectonic Atlas.
  
  
  RESULTS
  Twenty-one patients (31%) experienced major depressive episode. Larger lesions in the left cortical regions of the LCSPT circuit (3,760 vs. 660 mm3; P = 0.004) were associated with higher incidence of MDE. Secondary analyses revealed that major depressive episode was associated with larger lesions in areas of the medial prefrontal cortex including the ventral (BA24) and dorsal anterior cingulate cortex (BA32) and subgenual cortex (BA25); and also the subiculum (BA28/36) and amygdala (BA34).
  
  
  CONCLUSIONS
  Our findings indicate that depression due to stroke is aetiologically related to the disruption of the left LCSPT circuit and support the relevance of the medial prefrontal cortex dysfunction in the pathophysiology of depression.
authors.affiliation: Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, Medical School, University of São Paulo, São Paulo, Brazil. luterroni@gmail.com
authors.forename: Luisa
authors.initials: L
authors.lastname: Terroni
authors.forename: Edson
authors.initials: E
authors.lastname: Amaro
authors.forename: Dan V
authors.initials: DV
authors.lastname: Iosifescu
authors.forename: Gisela
authors.initials: G
authors.lastname: Tinone
authors.forename: João Ricardo
authors.initials: JR
authors.lastname: Sato
authors.forename: Claudia Costa
authors.initials: CC
authors.lastname: Leite
authors.forename: Matildes F M
authors.initials: MF
authors.lastname: Sobreiro
authors.forename: Mara Cristina Souza
authors.initials: MC
authors.lastname: Lucia
authors.forename: Milberto
authors.initials: M
authors.lastname: Scaff
authors.forename: Renério
authors.initials: R
authors.lastname: Fráguas
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000473:pathology* / Q000503:physiopathology; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000473:pathology*; D013997:Time Factors