J Neuropsychiatry Clin Neurosci 1990; 2:313-319
Copyright © 1990 by American Neuropsychiatric Association
Neuropathological findings in a suspected case of childhood schizophrenia
MF Casanova, N Carosella and JE Kleinman
Clinical Brain Disorders Branch, National Institute of Mental Health, Rockville, Maryland.
The ventral tegmental area (VTA) is the major dopaminergic (DA) center
responsible for the innervation of the prefrontal cortex, nucleus
accumbens, and entorhinal region. These areas have been causally implicated
in schizophrenia. Thus, the existence of brainstem pathology could explain
many of the previously reported findings in schizophrenic (SC) patients.
The authors focus on uncovering brainstem abnormalities in schizophrenia by
studying the autopsied material of a patient having an early onset of
symptomatology. The patient was evaluated at the age of 10 years for
manneristic behavior, a speech disorder, and violence. Prominent auditory
hallucinations became apparent years later. His mental status and ability
for self-care steadily deteriorated until he succumbed to pneumonia at age
22. Microscopic examination of the brain showed central chromatolysis of
neurons and mild gliosis in a restricted distribution of the brainstem and
thalamus. Cell loss and cytoarchitectural disruption were evident in the
frontal lobes, prepyriform cortex, and entorhinal region. The
neuropathological changes were interpreted as a chronic derangement in the
function of neurons of the rostral brainstem tegmental area and medial
thalamus with secondary involvement of their terminal projection sites.
