title: Evaluation of basal ganglia, brainstem raphe and ventricles in bipolar disorder by transcranial sonography.
abstract: Transcranial brain sonography (TCS) has become a reliable and sensitive diagnostic tool in the evaluation of extrapyramidal movement disorders. Alterations of brainstem raphe (BR) have been depicted by TCS in major depression but not in bipolar disorder. The aim of our study was to evaluate BR echogenicity depending on the different conditions of bipolar patients. Echogenicities of dopaminergic basal ganglia structures were assessed for the first time in bipolar disorder. Thirty-six patients with bipolar I disorder (14 depressed, 8 manic, 14 euthymic) were compared to 35 healthy controls. Echogenicities were investigated according to the examination protocol for extrapyramidal disorders using a Siemens Sonoline® Elegra system. The sonography examiner was blinded for clinical rating scores. Six patients (16.7%) showed hyperechogenicity of the substantia nigra. The raphe was hypoechogenic in 13 (36.1%) of the patients. No significant differences were seen between the subgroups. Compared to the control group, frequency of altered echogenicities did not reach statistical significance. The width of third ventricle was significantly larger in the patient group (3.8±-2.1 mm vs. 2.7±1.2 mm). Depressed bipolar patients with reduced BR echogenicity showed significantly higher scores on the Hamilton Depression Rating Scale as well as the Montgomery-Åsberg Depression Rating Scale. In contrast to unipolar depression, sonographic findings of bipolar patients may generally indicate structural integrity of mesencephalic raphe structures. If bipolar disorder coexists with hypoechogenic raphe structure, depressive symptoms are more severe.
authors.affiliation: Dept. of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstr. 56, Bochum, Germany. christos.krogias@rub.de
authors.forename: Christos
authors.initials: C
authors.lastname: Krogias
authors.forename: Kija
authors.initials: K
authors.lastname: Hoffmann
authors.forename: Jens
authors.initials: J
authors.lastname: Eyding
authors.forename: Dirk
authors.initials: D
authors.lastname: Scheele
authors.forename: Christine
authors.initials: C
authors.lastname: Norra
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.forename: Georg
authors.initials: G
authors.lastname: Juckel
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Assion
mesh_terms: D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000000981:diagnostic imaging* / Q000473:pathology; D001714:Bipolar Disorder / Q000000981:diagnostic imaging* / Q000473:pathology; D001931:Brain Mapping; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011903:Raphe Nuclei / Q000000981:diagnostic imaging* / Q000473:pathology; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*