In a previous cisternographic study of the cerebrospinal fluid (CSF) circulation in schizophrenic patients, indications for disturbed flow dynamics were found in 10 of 30 subjects. In order to replicate and investigate the clinical and pathophysiological significance of this finding, 39 schizophrenic patients and 42 healthy subjects were examined with an improved method for measurement of CSF circulation. 99mTc-DTPA was injected intrathecally and the gamma cisternograms were evaluated blindly. Correlations between cisternography findings and age, duration of disease, previous hospitalizations, positive or negative symptomatology, exposure to neuroleptics, psychiatric family history, CT findings and CSF levels of protein, tryptophan and monoamine metabolites, were calculated. Seven of the patients showed abnormalities in the cisternograms with a slow or obstructed flow of CSF over the convexities (P < 0.01) whereas none of the healthy volunteers showed abnormalities. There were no correlations between disturbed CSF circulation in the patients and the clinical and biochemical parameters, thus the significance of the deviations, similar to other biological aberrations found in schizophrenic patients, is not known. Recent developments in magnetic resonance imaging offer new possibilities to further examine CSF circulation abnormalities in schizophrenia.

En un estudio cistemográfico anterior de la circulación del líquido cefalorraquídeo (LCR) en pacientes esquizofrénicos, se encontraron señales de perturbación de la dinámica de flujo en 10 de 30 sujetos. Para replicar este resultado e investigar su significación clínica y patofisiológica, se examinaron 39 pacientes esquizofrénicos y 42 sujetos sanos con un método mejorado para la medición de la circulación del LCR. Se inyectó intratecalmente DTPA-Tc99“1 y se evaluaron a ciegas los cistemogramas gamma. Se calcularon correlaciones entre los resultados de la cistemografía y la edad, la duración de la enfermedad, las hospitalizaciones previas, los síntomas positivos o negativos, la exposición a neurolépticos, la historia psiquiátrica familiar, los hallazgos de TC y los niveles de proteína, triptófano y metabolitos de monoaminas en el LCR. Siete de los pacientes mostraron anomalías en los cistemogramas, con lentitud u obstrucción del flujo de LCR sobre las convexidades (P < 0,01), mientras que ninguno de los sujetos sanos mostró anomalías. No hubo correlaciones entre la perturbación de la circulación del LCR en los pacientes y los parámetros clínicos y bioquímicos. De este modo, se desconoce la significación de las desviaciones, similares a otras aberraciones biológicas encontradas en pacientes esquizofrénicos. Avances recientes en imágenes de resonancia magnética ofrecen nuevas posibilidades para examinar con mayor detenimiento las anomalías de la circulación del LCR en la esquizofrenia.

The cerebrospinal fluid (CSF) circulation was studied with isotope cisternography in 30 patients with a schizophrenic type of psychosis. All had previously received neuroleptic treatment. Disturbed CSF circulation was found in 10 cases. In four of these, persistent intraventricular radioactivity was observed as well as partly obstructed CSF spaces. In the other six cases a slow CSF circulation was noted as well as evidence of partly obstructed CSF spaces especially of the upper posterior frontal region. Signs of atrophy of the cortex and vermis were found on CT scan in 10 cases. In four of these subjects a local atrophy was noticed in the upper posterior frontal cortex and around the frontal part of the interhemispheric fissure. Seventeen of the patients (57 per cent) had pathological findings at isotope cisternography and/or at CT. Disturbed circulation did not correlate with CT-findings, age, duration of psychosis, alcohol abuse, drug consumption or family history for psychosis. CT evidence of brain atrophy was significantly related to nonfamilial type of psychosis.