논문제목: Post-stroke depression and emotional incontinence: correlation with the lesion location
Background and purpose The correlation between the location of stroke and post-stroke depression (PSD)
and emotional incontinence (inappropriate or excessive laughing and/or crying, PSEI) remains controversial.
Methods We prospectively studied 148 patients with single, unilateral stroke at 2-4 months after the onset of
stroke with regard to the presence of PSD (using DSM-IV criteria and Beck Depression Inventory) and
PSEI. The patients with prior history of depression were excluded. The lesion location was analyzed by CT
and/or MRI. Results There were 94 men and 54 women with their mean age of 61.5 years. Twenty seven
patients (18.2 %) had PSD and 50 (33.8 %) had PSEI. The lesions included 126 infarcts and 22 hemorrhages.
The presence of PSD and PSEI was not related to the laterality and the size of the lesion. The frequency of
PSEI but not PSD was higher in women (than in men) and in ischemic stroke (than hemorrhagic one) (p<
0.05, respectively). Although both PSD and PSEI were related to motor dysfunction and location (anterior vs.
posterior cortex) of the lesion, the latter was a stronger determinant for PSD (p<0.05). The frequency of
PSD and PSEI were: 75% and 100 % in the frontal stroke of anterior cerebral artery territory (n=4), 50 %
and 0 % in temporal lobe stroke (n=4), 30 % and 40 % in predominantly frontal stroke of middle cerebral
artery territory (n=10), 19 % and 45.2 % in lenticulocapsular stroke (n=42), 12.5 % and 0 % in occipital
stroke (n=8), 10.5 % and 15.8 % in thalamic stroke (n=19), 0 % and 33.3 % in midbrain stroke (n=3), 15.8 %
and 52.6 % in pontine base stroke (n=19), 36.4 % and 54.5 % in medullary stroke (n=11) and 0 % and 22.2 %
in cerebellar stroke (n=9), respectively. No patients with lesions at parietal lobe (n=10) and dorso-lateral pons
(n=5) exhibited PSD or PSEI. PSEI was more closely associated with lenticulocapsular strokes as compared
to PSD (p<0.01).
It has been well known that patients often develop depression after the occurrence of stroke
(Ghika-Schmid, Starkstein). The frequency of this post-stroke depression (PSD) has been reported to range
from 12 % to 64 % (Robinson 1984, Ebrahim 1987;Herrmann 1995;Sinyor 1986;Ebrahim, 1987;Wade
1987;Starkstein, 1989;House 1991 ). The wide variation in the frequency of PSD seems to be attributed to
methodological heterogeneity including the differences in criteria for depression, time of assessment after
stroke and the sampled subject population. Equally controversial, however, has been the relationship between
the location of stroke and PSD. Despite numerous reports regarding PSD, anatomical substrates have been
poorly studied in many of the previous literature. Thus, while some reported that PSD occurred more often
after left anterior lesion (Robinson et al, 1984), other have addressed the importance of right sided lesion in
producing this symptom (Dam et al, 1989; MacHale, 1998), and still others failed to find any evidence of
association of PSD with the lesion location (Anderson al, 1995; Burvill et al, 1996;Hermann et al, 1998
Pohjasvaara et al, 1998).