The study on clinical characteristics and relationship between levels of depression and cranial MRI in patients with lacunar infarcts in supratentorial region

Journal of military pharmaco-medicine no5-2018

THE STUDY ON CLINICAL CHARACTERISTICS AND
RELATIONSHIP BETWEEN LEVELS OF DEPRESSION AND
CRANIAL MRI IN PATIENTS WITH LACUNAR INFARCTS
IN SUPRATENTORIAL REGION
Dang Viet Hung*; Nguyen Minh Hien**; Nguyen Tram Anh***
SUMMARY
Objectives: To study clinical characteristics, and relationship between levels of depression
and cranial MRI of patients with lacunar infarction. Subjects and methods: Cross-sectional study
and self-design research questionnaire. A total of 90 patients with lacunar infarcts and signs of
depression collected from Department of Neurology of Viet - Czech Friendship Hospital between
March 2013 and May 2015. Results: The time of onset of lacunar infarction from 6 to 12 am
accounted for 53.33%. Among onset symptoms in the majority of patients, hemiplegia accounted
for 85.56%, and language disorders accounted for 55.56%, motor dysfunction accounted for 60%.
Mild depression, moderate depression, severe depression accounted for 43.33%, 35.56%, and
21.11%, respectively. Locations of lacuna in internal capsule, gray matter, and temporal lobe have
not been found to affect levels of depression in cerebral infarction. Frontal lobe damage increased
the risk of severe depression by 7.31 times than that of mild depression and 5.81 times than that
of moderate depression. Left cerebral hemisphere damage increased the risk of severe depression
4.88 times more than mild depression. Conclusion: There is no clear relationship between levels
of depression and cranial MRI in patients with lacunar infarction.
* Keywords: Lacunar infarction; Clinical characters; Level of depression; Cranial MRI.

INTRODUCTION
Stroke has become an increasingly
important medical problem due to the
average life increasing more and more,
the stroke rates have increased according
to the age. It is predicted that if there were
12.8% of Americans > 65 years had stroke

in 1995, there would be 18.7% in 2025.
Lacunar infarction, which accounts for 20
to 26% of total cerebral infarction cases,
results from occlusion of penetrating
branches that cause small lacuna; necrotic
brain tissues forms a small sinus. The question
is that whether there is a relationship
between the dominant brain hemisphere

damage and depression after a stroke.
Previous studies have shown that patients
with left hemisphere infarction, especially
those with frontal lobe damage, are more
likely to suffer from depression. Today,
thanks to diagnostic imaging devices,
medical images become more sensitive
and specific. In the world, there are many
studies on the relationship between
depression after stroke and locations of
brain damage. At present, there are not
many studies on this issue in Vietnam,
so the relationship between depression
levels and cranial imaging in patients with
lacunar infarction in supratentorial region.

*
**
***
Corresponding author: Dang Viet Hung ()
Date received: 26/02/2018

Date accepted: 30/05/2018

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Journal of military pharmaco-medicine no5-2018
SUBJECTS AND METHODS
1. Subjects.
90 patients diagnosed with lacunar
infarction were treated at Department of
Neurology of Vietnam - Czech Friendship
Hospital from March 2013 to November
2015.
- The subjects fully met the criteria for
diagnosis of lacunar infarcts, on CT-scans
or MRI.
- All patients were diagnosed with
depression according to ICD 10 (1992).
- Patients were conscious and cooperated
in the process of medical examination,
consultation and research.
- Patients gave consent to research.
* Exclusion criteria:
- Patients with other severe diseases.
- Patients with a history of depressive
symptoms prior to admission.
- Patients do not cooperate in the medical
examination and inquiry.
- Patients with clinical symptoms, but
without infarction on MRI.

- Patients with cerebral infarction caused
by brain tumors, injury, infection, cerebral
hemorrhage, and so on.
2. Methodology.
- Cross-sectional description
- The patients in the study group were
monitored from hospital arrival to discharge.
- Self-designed research questionnaire.
194

- Use of the Beck Depression Inventory
(BDI) to assess the severity of the patients’
depression.
- Use of SPSS 16.0 software and Excel
software to process data.
RESULTS AND DISCUSSION
* The time of onset of lacunar infarction:
The most common time of infarction to
occur was from 6 am to 12 pm, accounting
for 53.33% (48 patients). The second
most common time was 12 pm - < 6 pm,
accounting for 26.67% (24 patients).
12 am - < 6 am accounted for 12.22%
(11 patients). 6 pm - < 12 am occupied
the least percentage (7 patients = 7.78%).
According to Nguyen Thi Thu Huyen and
Nguyen Van Chuong, stroke onset time in
was generally from 6 to 12 hours, followed
by 12 - 18 hours (during work hours).
* Onset symptoms:

Cognitive decline: 16 patients (17.78%);
hemiplegia: 77 patients (85.56%); sensory
disorder: 19 patients (21.11%); language
disorder: 50 patients (55.56%); swallowing
disorders: 8 patients (8.89%); epilepsy:
1 patient (1.11%); hemianopia: 0;
coordination disorder: 3 patients (3.3%).
According to Nguyen Van Oanh, the most
common onset symptoms were motor
hemiplegia in 92.2%, language disorders
in 44%, and cognitive disorders in 16%.
According to Phuong Viet Trung, the
proportion of hemiplegia in patients with
lacunar infarcts accounted for 98.1%.
Duong Tuan Bao showed that the rate
of 93.7%.


Journal of military pharmaco-medicine no5-2018
Table 1: Clinical symptoms of lacunar infarction.
Symptoms

Pure motor hemiplegia

n = 90

Rate %

Face - Hand - Foot

33

61.11

Dominant hand paralysis

14

25.93

Dominant foot paralysis

7

12.96

60.0

Communication disorder and hand clumsiness

2

2.22

Sensory and motor disorder

12

13.33

Hemiparesis and ataxia

11

12.22

Pure sensory disorder

11

12.22

Pure motor hemiplegia accounted for the highest rate at 60%. Some studies in Vietnam
showed the similar rate, ranging from 51% to 53%. Study of Gan. R showed the rate of
45% and that of Landi. G was 70%. There was a low percentage of language disorder and
hand clumsiness at 2.22%. The study results matched those of Le Van Thu and Nguyen
Van Oanh.
* Results from the shortened Beck Depression Inventory:
In our 90 patients, the prevalence of mild depression was 43.33% (39 patients),
moderate depression accounted for 35.56% (32 patients), and severe depression accounted
for 21.11% (19 patients).
According to Dang Hoang Anh, when studying the clinical characteristics of mental
disorders in stroke patients with hypertension, the findings showed that mild depression
accounted for 23%, moderate depression accounted for 10%, and severe depression
was 2%. The rates of depression in our study were higher compared to Dang Hoang
Anh's, because patients with depression had been screened for inclusion in the study.
Table 2: Relationship between levels of depression and locations of lacuna in
internal capsule.
Locations of lacuna
Levels of

depression

Internal capsule
(n = 51)

Other
(n = 39)

Total
(n = 90)

p

OR
(95%CI)

n

%

n

%

Mild (1)

22

56.41

17

43.59

39

p3.1: 0.914

1,07 (0.31 - 3.78)

Moderate (2)

18

56.25

14

43.75

32

p2.1: 0.989

0.99 (0.35 - 2.84)

Severe (3)

11

57.89

8

42.11

19

p3.2: 0.909

1.07 (0.29 - 3.97)

The prevalence of depression was similar in patients with internal capsule damage.
The difference is not statistically significant.
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Journal of military pharmaco-medicine no5-2018
Table 3: Relationship between levels of depression and locations of lacuna in thalamus.
Locations of lacuna
Levels of
depression

Thalamus
(n = 19)

Other
(n = 71)

Total

(n = 90)

p

OR
(95%CI)

n

%

n

%

Mild (1)

7

17.95

32

82.05

39

p3.1: 0.460

Moderate (2)

7

21.88

25

78.12

32

p2.1: 0.679

Severe (3)

5

26.32

14

73.68

19

p3.2: 0.718

1.63
(0.34
- 7.19)

1.28
(0.33
- 4.89)
1.28
(0.26 - 5.72)

Patients with thalamus lesions had a 1.63-times greater risk of major depression than
mild depression. However, this difference was not statistically significant with p > 0.05.
Table 4: Relationship between levels of depression and locations of lacuna in
frontal lobe.
Locations of lacuna
Levels of
depression

Frontal lobe
(n = 5)

Other
(n = 85)

p

OR
(95%CI)

Total
(n = 90)

n

%

n

%

Mild (1)

1

2.56

38

97.44

39

p3.1: 0.062

7.13 (0.51 - 383.55)

Moderate (2)

1

3.13

31

96.87

32

p2.1: 0.887

1.23 (0.02 - 98.72)

Severe (3)

3

15.79

16

84.21

19

p3.2: 0.104

5.81 (0.41 - 314.69)

Patients with frontal lobe lesion were more likely to get severe depression 7.14 times
than mild depression and 5.81 times than moderate depression. However, the difference
was not statistically significant with p > 0.05.
Table 5: Relationship between levels of depression and locations of lacuna in left
hemisphere.
Locations of lacuna

Levels of
depression

Left hemisphere
(n = 40)

Other
(n = 50)

p

OR
(95%CI)

Total
(n = 90)

n

%

n

%

Mild (1)

12

30.77

27

69.23

39

p3.1: 0.007

4.88 (1.3 - 19.16)

Moderate (2)

15

46.88

17

53.12

32

p2,1: 0.164

1.99 (0.67 - 5.88)

Severe (3)

13

68.42

6

31.58

19

p3.2: 0.135

2,46 (0.65 - 9.83)

Patients with left hemisphere lesions had a 4.88-times greater risk of major
depression than mild depression (95%CI: 1.30 - 19.16). The difference is statistically
significant with p < 0.05.
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Journal of military pharmaco-medicine no5-2018
Table 6: Relationship between levels of depression and locations of lacuna in right
hemisphere.
Locations of lacuna
Levels of
depression

Other
(n = 54)

Right hemisphere

(n = 36)

Total
(n = 90)

p

OR
(95%CI)

n

%

n

%

Mild (1)

16

41.03

23

58.97

39

p3.1: 0.487

0.66 (0.17 - 2.39)

Moderate (2)

14

43.75

18

56.25

32

p2.1: 0.817

1.12 (0.39 - 3.19)

Severe (3)

6

31.58

13

68.42

19

p3.2: 0.389

0.59 (0.15 - 2.24)

The prevalence of depression was similar in patients with right hemisphere lesions.
The difference is not statistically significant with p > 0.05.
According to Duong Minh Tam, patients
have infarction in various locations. Temporal
lobe infarction is the most common, in
which 13.6% of the left temporal lobe,
20.2% of the right temporal lobe. Comparing
depression rates between left hemisphere
and left hemisphere, the authors found
that depression caused by left hemisphere
injury was 95%CI, but risk factors was not
statistically significant with OR = 1.052
(0.61-1.81). According to Vataja R et al,
typical depression was not related to
cerebral injury locations while atypical
depression was. Bhogal et al argued that
the location of post-stroke brain injury only
played a role when depression occurred
in the early stages of infarction. Clarke
and colleagues found that the association
between cerebral lesions and post-stroke
depression, patients with left hemisphere
injury had higher rates of depression than
those with right hemisphere one. They also

reviewed recent studies and found that in
patients with stroke in the early stages
after onset or during hospitalization, left

hemisphere injury was related to depression
after infarction.
CONCLUSION
According to the study on 90 patients
diagnosed with lacunar infarcts suffering
from depression, treated in the Department
of Neurology of Viet - Czech Friendship
Hospital from March 2013 to May 2015,
the following conclusions were drawn:
- The most frequent onset time of
lacunar infarction was from 6 am to 12 am,
accounting for 53, 33%.
- Onset symptoms of the majority of
patients were hemiplegia accounting for
85.56%, and language disorders accounting
for 55.56%.
- Regarding the symptoms of lacunar
infarction, pure motor hemiplegia accounted
for the highest rate of 60%.
- Mild, moderate, and severe depression
accounted for 43.33%, 35.56%, and 21.11%,
respectively
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Journal of military pharmaco-medicine no5-2018

th

- Locations of lacuna in internal capsule,
gray matter, and temporal lobe did not affect
the levels of depression in lacunar infarction.

on the 47 anniversary of establishment of
Department of Neurology. Bach Mai Hospital.
2003.

- Frontal lobe injury was more likely
to cause severe depression 7.14 times
than mild depression and 5.81 times than
moderate depression.

5. Nguyen Van Oanh. Study of clinical
features, MRI, and causes of lacunar infarction.
Dotoral Thesis. Hanoi Medical University. 2006.

- Left hemisphere injury caused a 4.88times greater risk of major depression
than that of mild depression.
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