Neuropathological findings in a suspected case of childhood schizophrenia

The ventral tegmental area (VTA) is the major dopaminergic (DA) center responsible for the innervation of the prefrontal cortex, nucleus accumbens, and entorhinal region. These areas have been causally implicated in schizophrenia. Thus, the existence of brainstem pathology could explain many of the previously reported findings in schizophrenic (SC) patients. The authors focus on uncovering brainstem abnormalities in schizophrenia by studying the autopsied material of a patient having an early onset of symptomatology. The patient was evaluated at the age of 10 years for manneristic behavior, a speech disorder, and violence. Prominent auditory hallucinations became apparent years later. His mental status and ability for self-care steadily deteriorated until he succumbed to pneumonia at age 22. Microscopic examination of the brain showed central chromatolysis of neurons and mild gliosis in a restricted distribution of the brainstem and thalamus. Cell loss and cytoarchitectural disruption were evident in the frontal lobes, prepyriform cortex, and entorhinal region. The neuropathological changes were interpreted as a chronic derangement in the function of neurons of the rostral brainstem tegmental area and medial thalamus with secondary involvement of their terminal projection sites.