Non-contrast T1 Weighted Coronal MRI of a 52 year old male with chronic schizophrenia.
Image 2 of an MRI scan of a 50 year old male with no known neurological or psychiatric problems is for comparison only purposes with the MRI scan of the patient with chronic schizophrenia in Image 1. The main findings of Image 1 are highlighted by the numbered arrows and include enlargement of the lateral ventricles which are the two highest chambers in the brain (arrow 1). Cerebral-spinal fluid (CSF) is produced in the choroid plexus within the ventricles. Compare the ventricles in this image with the much smaller ones in the control patient in Image 2 below. The second arrow, (Arrow 2) shows Cerebral-Spinal fluid in the left temporal horn and Arrow 3 indicates increased Cerebral-Spinal fluid in the left Sylvian fissure. The Sylvian fissure divides the lobes of the human brain and is easily discernible as a deep, lateral indentation.
A study of CT scans by Johnstone and colleagues, as early as 1976, found lateral ventricular enlargement in schizophrenic patients.(1) Since that time, especially with the introduction of MRI scans, significant progress has been made in identifying physiological abnormalities of the brain in patients with schizophrenia. MRI studies of 193 cases between 1988 to August 2000 have led to more definitive findings of brain abnormalities in schizophrenia than any other period of historical research.(2) One of the main findings is ventricular enlargement, identified in 80% of the studies, especially third ventricle enlargement (73% of the studies). Also evident was involvement of medial temporal lobe structure (74% of studies) including the amygdale, hippocampus and parahippocampal gyrus. The neocortical temporal lobe region (the superior temporal gyrus) was involved in 100% of studies. 67% of cases showed abnormalities in grey and white matter of the temporal gyrus.(3) To summarize, modern imaging techniques in cases of schizophrenia show an overall reduced brain volume of around 3% in some cases, with gray matter more affected than white matter.(4) Enlarged ventricles and reduction in the volume of subcortical gray matter of frontal and temporal lobes and the limbic system.
Some definitions describe schizophrenia as a brain disorder and some as a mental illness or psychotic disorder. Schizophrenia is often characterized by a failure to recognise what is real, or by a person interpreting reality abnormally. Symptoms can vary dramatically from person to person, both in pattern and severity, and they can also change over time. The main symptoms of schizophrenia include hallucinations, delusions and disorganized speech and behaviour. ‘Negative’ symptoms can also occur and refer to a withdrawal, so the person can appear emotionless and lack the ability to sustain activities or derive pleasure from life. The prevalence of schizophrenia varies substantially according to how it is defined.(5) On a global scale, it is estimated that schizophrenia affects 0.3 – 0.7% of people or 24 million people worldwide as of 2011.(6)
1,2,3. Shenton ME1, Dickey CC, Frumin M, McCarley RW. ‘A review of MRI findings in schizophrenia’. Schizophr Res. 2001 Apr 15;49(1-2):1-52.
4. Wrigh IC, Rabe-Hesketh S, Woodruff PWR, David AS, Murray RM, Bullmore ET. ‘Meta-analysis of regional brain volumes in schizophrenia’. Am J Psychiatry 2000; 157: 16–25.[PubMed]
5. Kirkbride JB, Fearon P, Morgan C, et al. ‘Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study.’ Archives of General Psychiatry. 2006;63(3):250–8. doi:10.1001/archpsyc.63.3.250. PMID 16520429.
6 ‘Schizophrenia’. World Health Organization. 2011. Retrieved February 27, 2011.