The microvascular alterations in frontal cortex during treatment with antipsychotics: a post-mortem study

Vol. 57 No. 2 Suppl., 2016
This supplement was not sponsored by Outside Organizations.

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Ion Udristoiu, Ileana Marinescu, Mihail-Cristian Pirlog, Felicia Militaru, Tudor Udristoiu, Dragos Marinescu, Mihai Mutica

Introduction: Schizophrenia is the most severe psychiatric illness, with a biological support in the brain. There is evidence that the adequate dopamine balance in the frontal cortex is associated with a better outcome of the disorder, while the alteration of dopamine mechanism at this level may affect the vascular system leading to secondary neuronal alterations. Our study was conducted post-mortem and its objective was to identify the alterations in the neuronal architecture, in the integrity of the microvascular unit in the frontal cortex of patients treated with potent and excessive D2-blocking antipsychotics. Materials and Methods: We studied post-mortem sections of the frontal cortex of three patients (two women and one man) diagnosed with schizophrenia or schizophrenia-spectrum disorders and treated with antipsychotics for the last 24 months. The slides were prepared according to the classical histopathological protocols. Results: Various alterations were found at the neural and vascular levels in the frontal cortex. The most significant was the neural loss as the result of severe changes in the microvessels (diameter reduction, hyaline and collagen deposits, edema, pinocytosis and vacuolization). Discussion: The evidences shown in our study highlight the fact that antipsychotics with potent antagonist action on D2 receptors may affect the neurovascular unit and small vessels in frontal cortex by altering the balance vasoconstriction-vasodilatation, thus reducing the blood flow and metabolism and generating structural microvascular changes proportional with the level of apoptosis at this level. The functional integrity of the dopaminergic system in frontal cortex depends on the vascular support and the capabilities of the neurovascular unit and any dysfunction increases the neuronal loss with clinically significant changes. Conclusions: The pathological data of our study raises the hypothesis for the pathogenic stages at the level of microvessels in the frontal cortex of the patients with schizophrenia or schizophrenia-spectrum disorders treated with D2-blocking antipsychotics: a stage with functional, reversible alterations that may be correlated with the impairments of working memory and presence of extrapyramidal symptoms and a lesional, irreversible stage with significant deterioration of cognition and global functioning. Further studies are needed to verify this hypothesis.

Corresponding author: Ileana Marinescu, Lecturer, MD; e-mail: marinescu_psy@yahoo.com

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ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Pompiliu Horatiu Petrescu, Dragos Andrei Izvernariu, Catalina Iancu, Gabriel Ovidiu Dinu, Dan Crisan, Simona Alina Popescu, Roxana Lucia Denisa Sirli, Bogdan Mihai Nistor, Ion Calin Rautia, Dorela Codruta Lazureanu, Sorin Dema, Ion Radu Prejbeanu, Ioan Sporea

Tendinopathy covers a range of several tendon conditions, mostly caused by overuse but at least in Achilles tendon pathology, favored by obesity, diabetes, inflammatory and autoimmune conditions. Subclinical tendon pathology is difficult to diagnose, as magnetic resonance imaging (MRI) examinations are sometimes inconclusive and not cost-effective. Elastography is an ultrasound examination method that uses mechanical impulses to produce shear waves in the tissue of interest, then measures the tissue displacement and calculates the shear wave speed or the elastic modulus of the examined tissue. We have used B-mode ultrasonography and shear wave elastography on 80 Achilles tendons from healthy volunteers with or without tendon pathology history, and correlated the data obtained with the clinical parameters of the volunteers, such as age, body mass index (BMI) and sports practice. We have shown that there is no significant correlation between the elastic modulus of the Achilles tendon and age, sports practice and body mass index with the exception of the correlation between the elastic modulus of the right Achilles tendon in men and age. Shear wave elastography has proved to be cost-effective for the evaluation of the Achilles tendon in healthy volunteers and was able to monitor the evolution of one patient with old tendon rupture treated by surgery. It can complete MRI investigation and it can replace B-mode ultrasonography particularly in monitoring the post-surgery evolution.

Corresponding author: Pompiliu Horatiu Petrescu, Assistant Professor, MD, PhD; e-mail: lalusha87@yahoo.com

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