Chronic Electroconvulsive Therapy May Induce Calvarial Hyperemia and Marrow Replacement

Area of Science:

• Neuroradiology
• Psychiatry
• Bone Marrow Imaging

Background:

• Electroconvulsive therapy (ECT) is a vital treatment for severe psychiatric conditions like major depression and obsessive-compulsive disorder.
• Historically, ECT has not been associated with structural bone changes.

Observation:

• A patient with refractory obsessive-compulsive disorder and depression, treated with frequent ECT, incidentally showed an unusual finding on MRI.
• This finding included increased enhancement and signal loss in the right frontal bone marrow, directly under the ECT electrode site.

Findings:

• Radiological evaluation, including CT and bone scan, ruled out bone destruction or metastatic disease.
• The observed bone marrow changes were consistent with hyperemia, likely induced by chronic electrical stimulation from ECT.
• These findings were stable over a 4-month follow-up period.

Implications:

• This case introduces a novel, previously undescribed complication of frequent, chronic ECT: asymptomatic skull bone marrow hyperemia.
• The findings suggest that the electrical current from ECT may cause localized chronic inflammation and edema in the bone marrow.
• Electroconvulsive therapy should be considered in the differential diagnosis for calvarial enhancement and bone marrow signal abnormalities, and patients should be informed of this potential rare finding.