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Yıl:2009; Cilt: 10; Sayı: Ek 1>> Özet
Anadolu Psikiyatri Dergisi; 2009;10(Ek 1):93-94
Korpus kallosumun total agenezisi: Bir şizofreni olgusunda gelişen yürüme bozukluğu
CF Demir
Elazığ Eğitim ve Araştırma Hastanesi Nöroloji Kliniği, Elazığ
Giriş: Korpus kallosum korteksten köken alan uyaranları karşı taraf hemisfere bağlayarak beynin motor, duyusal ve kognitif performansını sağlamaktadır. Kallosal disgenezi genellikle epilepsi veya kognitif hastalıkların araştırılması sırasında planlanan görüntüleme yöntemleri ile hormonal etkenler, hipoksi gibi çeşitli nedenler parsiyel veya komplet disgenezisine neden olabilir. Bir çalışmada psikotik bipolar hastalarda korpus kallosum alanları küçük bulunmuştur. Bu bulgular bir grup başka araştırmacı tarafından genu, posterior ve istmus bölgelerinde küçülmenin saptandığı bir çalışma ile desteklenmiştir.Olgu: Yirmi dört yaşında, sağ elli, erkek hasta, 10 yıldır dezorganize şizofreni tanısı ile tedavi altında olduğu, yürürken bazen ataksisi olması nedeni ile polikliniğimize yönlendirildi. Öyküsünde bu yürüme bozukluğunun son bir yıldır artarak sürdüğü bildirildi. Nörolojik muayenesi hafif ataksi dışında normaldi. İlaç yan etkisi olabileceği de akılda tutularak laboratuar tetkikleri istendi. Beyin manyetik rezonans görüntülemede korpus kallosumun total agenezisi izlendi. Ancak yürüyüş bozukluğunun bir yıldır olması bu doğumsal malformasyonla zayıf ilişkili olabileceğini düşündürdü. Elektroensefalografisinde iki temporoparieteal bölgede de nonspesifik yavaş dalgalar şeklinde anormallik izlendi. Ataksik yürümenin Andermann's sendromunda görülen polinöropatiden kaynaklanabileceği düşünülerek sinir iletim çalışması yapıldı, normal olarak değerlendirildi. Tartışma: Bu olgudaki yapısal anomalinin hastalık başlangıcından önce oluşup kişide bozukluk için yatkınlık mı oluşturduğu, ya da yineleyen ataklar veya ilaç tedavisi sonucu yürüme bozukluğu mu geliştiği konusu açık değildir. Korpus kallozumdaki anormalliğin eşlik ettiği, pozitif belirtileri (sanrılar, varsanılar) belirgin olan bu hastada, tedaviye yanıtsızlık ve/veya zayıf yanıt nedeni ile çoklu ila ve yüksek dozda ilaç kullanılması, yürüme bozukluğu ile ilişkilendirilebilir.
Total agenesis of corpus callosum: gait disorder in a schizophrenia case
Objective: Corpus callosum plays an integrative role in the transmission of sensitive, motor, and cognitive information coming from the homolo-gous areas of the cerebral hemispheres. Callo-sal disgenesia is usually detected by the imaging methods that are scheduled for the invest-tigation of epilepsy or cognitive diseases. The formation of the corpus callosum occurs between 8 and 20 weeks? gestation. Such as infections, maternal hormonal factors, hypoxi can cause partial or complete agenesis of the corpus callosum. The corpus callosum areas were found to be smaller in the patients having psychotic bipolar disease. The findings in this investigation have been supported by an other group of investigators describing involution in the genu, posterior and isthmus areas. Case: A 24 [year]s old, right handed male patient who have been on therapy for 10 [year]s with the diagnosis of having disorganized schizophrenia was referred to our clinic for having ataxia while walking. His history revealed that this ataxic attitude have been present for a [year] with in-creasing frequency and severity. His neurological examination showed mild ataxia and was otherwise normal. By primarily keeping in mind the possibility for drug toxicity as the causative factor of this clinical presentation laboratory tests were sent for assessment. The brain mag-netic resonance imaging unveiled total agenesis of the corpus callosum. As his history with the walking disorder had a past of a [year] this led us to think that it could hardly be related with this congenital malformation. His electroencephalogram showed an abnormality in terms of non-specific slow waves in bilateral temporo-parietal regions. As ataxic walking could also be associated by the polyneuropathy seen in the Ander-mann's syndrome we also performed neuro-conductive tests as well which turned out to be normal. Discussion: In this case, it is not very easy to tell in terms of this walking disorder whether it is to be due to the structural anomaly that caused a predisposition for the disease by being developed before the onset of the disease or repetitive attacks or drug therapy. On the other hand, in this patient having attendance of the striking abnormality in the corpus callosum and the evident positive symptoms (delusions, hallucinations) usage of multiple drugs and administration of highest limit doses for the therapy due to the presence of resistance and /or weak response to treatment may be associated with the walking disorder.

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