Affective disorders in subcortical ischemic cerebrovascular pathology. Prospective clinical study of 43 patients

To evaluate the prevalence and clinical features of affective disorders (AD) associated with subcortical ischemic cerebrovascular disease (mainly localized in the deep areas depending from the anterior, middle and posterior cerebral arteries), a prospective clinical study was carried out in 43 patients with lacunar infarctions (LI). It was found that AD were uncommon in these patients (25%) (1/43). The prevalences of depression in the major lacunar syndromes of the series were the following, from more to less common: pure motor hemiparesis (35%) (7/20); dysarthria-clumsy hand (25%) (1/4); pure sensorial syndrome (16.5%) (2/12), and atypical syndromes (no patient). The capsular topography was associated with AD in 32% (7/22); this association was more uncommon in thalamic (15%) (2/13) or pontine (25%) (1/4) areas. AD had a significant predominance (p = 0.027) in the lesions involving the dominant cerebral hemisphere (63.5%), mainly when these resulted in clinically mild or moderate/severe disability. Past history of AD was also significantly associated with depression (p = 0.0018). Our results show that affective disorders in lacunar infarctions are usually associated with: 1) the type of clinical syndrome; 2) the topography of the lesion; 3) the involved cerebral hemisphere; 4) the associate neurological focality, and 5) the previous occurrence of affective disorders.