Fetal alcohol syndrome and secondary schizophrenia: a unique neuropathologic study

Abstract

We report the unique neuropathologic study of an adult brain of a patient with fetal alcohol syndrome who developed the well-recognized complication of schizophrenia in adolescence. The major finding was asymmetric formation of the lateral temporal lobes, with marked enlargement of the right superior temporal gyrus, suggesting that alcohol is preferentially toxic to temporal lobe patterning during gestation. Critical maturational changes unique to adolescence can unmask psychotic symptomatology mediated by temporal lobe pathology that has been clinically dormant since birth. Elucidating the neuropathologic basis of the secondary psychiatric disorders in fetal alcohol syndrome can help provide insight into their putative developmental origins.

Keywords: areal patterning; schizophrenia; superior temporal gyrus.

Figure 1.

A. The right cerebral hemisphere is notable for a disproportionately enlarged lateral temporal lobe (dotted lines), giving the brain an overall globular appearance with a foreshortened frontal pole. The superior temporal sulcus (asterisk) that divides the superior temporal and middle temporal gyri is deep, open, and cleft-like. Straight, diagonal artifacts (Artifact) related to brain removal at autopsy are present. B. The medial surface of the right hemisphere is intact. The corpus callosum (CC) was without total or partial agenesis. The cerebellum is without atrophy of the vermis and/or lateral hemisphere (not shown). Abbreviations; CG, cingulate gyrus; CS, calcarine sulcus; FX, fornix; MTT, Mammillothalamic tract; OC, optic chiasm; POS, parieto-occipital sulcus; RO, rostrum of the corpus callosum; SP, splenium of the corpus callosum.

Figure 2.

The temporal lobe of our FAS case (B) is compared to that of an adult control (A) (bar = 15 centimeters). In the FAS case, the superior temporal gyrus (STG) is abnormally enlarged with a smooth planum temporale and deep, cleft-like superior temporal sulcus separating the STG from the underlying middle temporal gyrus. The hippocampus (HIPP) and parahippocampal gyrus (BA 28) in the medial temporal lobe are grossly comparable in formation between the FAS case (B) and control (A). The thalamus, basal ganglia, hippocampus, parahippocampus gyrus, amygdala (not shown), and hypothalamus (not shown) are intact at the gross and microscopic (not shown) levels. In the STG of the patient (C), there are fetal-like, vertical columns compared to the normal STG (D). At higher power, the neuropil is cell-sparse and abnormally widened in the FAS case (E) compared to the control (F). Hematoxylin-and-eosin, scale bars in place.