INVESTIGADORES
ALLEGRI Ricardo F.
congresos y reuniones científicas
Título:
Abrupt disruption of nicotine addiction and aphaty after strategic acute brain ischemia
Autor/es:
167. BAGNATI P, FERNANDEZ SUAREZ M, RODRIGUEZ J, CHREM P, CALVAR J, VENTRICE F, MELI F, CAMPOS J, AMENGUAL A, COHEN G, RUSSO A, ALLEGRI R
Reunión:
Congreso; Annual Meeting of the American Academy of Neurology; 2013
Institución organizadora:
American Academy of Neurology
Resumen:
OBJECTIVE:
To analyze shared mechanism of nicotine addiction and apathy by clinical
assessment, magnetic resonance imaging (MRI) and Difussion Tensor Imaging(DTI).
BACKGROUND:
Cigarette addiction is related to the reward pathway that includes the
tegmental area connected by the medial forebrain bundle (MFB) to the
hypotalamus, accumbens nucleus (NAcc) and the fronto orbital cortex (FO).
Apathy is related to the damage of the cingulated gyrus and disruption of
networks connecting frontal structures with caudate nucleus, pallidum and
thalamus.
DESIGN/METHODS:
RMI 1,5 tesla MRI and DTI, neuropsychiatric and cognitive assessment.
RESULTS: A 62 year old
patient with a history of active smoker (30 pack/year), Fagerström Nicotine
Dependence Scale: 6 developed sudden onset of apathy (Starkstein Apathy
Scale:38) with spontaneous cessation of cigarette smoking without withdrawal
symptoms. Social withdraw and indifference was reported by relatives. No
significant depressive symptoms were detected. Social Perception measured by
"Reading the Mind in the Eyes" Test was abnormal. MRI showed an acute
right FO stroke (medial and lateral FO cortex, frontal pole and underneath
white matter); DTI showed decreased fiber density of cingulated bundle,
uncinate faciculus and medial forebrain bundle in the right. NAcc was
preserved. Old ischemic strokes located in the left caudate head and pallidum
were detected as well.
CONCLUSIONS: Immediate smoke cessation without withdrawal symptoms was observed
after a FO lesion with disruption of pathways related to reward. Apathy is
unusual in a small frontoorbital lesion. The cingulum bundle was affected
without any evidence of anterior cingulum injury, suggesting that some circuits
from FO cortex that are passing trough were theoretically related to apathy
development. Apathy and smoke cessation could have been related to a
"functional" bilateral fronto-subcortical circuit damage due to the
combination of old left pallidal and caudate stroke with a deaferentation of
the right basal ganglia.