Neural injury and recovery near cortical contusions: a clinical magnetic resonance spectroscopy study

Nakabayashi, Motoaki; Suzaki, Shinichiro; Tomita, Hiroki

doi:10.3171/jns.2007.106.3.370

Cited by 36 publications

(18 citation statements)

References 39 publications

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“…The rationale for investigating the use of this magnetic resonance spectroscopicbased technique in mTBI comes from the experimental evidence that this type of brain injury induces NAA depletion over time with subsequent recovery to preimpact levels (68,69,73,77,78). Clinical support for this phenomenon was recently reported by Nakabayashi et al (56) in a series of 30 patients (Glasgow Coma Scale scores of 9-15, including 12 mTBIs), who demonstrated a reduction in the NAA-to-Cr ratio in normal-appearing white matter at 1 week postinjury that spontaneously normalized at 1 month (56). All of the aforementioned authors reached the unanimous conclusion that 1 H-MR spectroscopic observation of neurometabolites can give valuable information about the neuronal dysfunction, which is "invisible" with structural neuroimaging modalities.…”

Section: Use Of 1 H-mr Spectroscopy In the Evaluation Of Concussionmentioning

confidence: 93%

Temporal Window of Metabolic Brain Vulnerability to Concussion

et al. 2008

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OBJECTIVE:In the present study, the occurrence of the temporal window of brain vulnerability was evaluated in concussed athletes by measuring N-acetylaspartate (NAA) using proton magnetic resonance ( 1 H-MR) spectroscopy. METHODS: Thirteen nonprofessional athletes who had a sport-related concussive head injury were examined for NAA determination by means of 1 H-MR spectroscopy at 3, 15, and 30 days postinjury. All athletes but three suspended their physical activity. Those who continued their training had a second concussive event and underwent further examination at 45 days from the initial injury. The single case of one professional boxer, who was studied before the match and 4, 7, 15, and 30 days after a knockout, is also presented. Before each magnetic resonance examination, patients were asked for symptoms of mild traumatic brain injury, including physical, cognitive, emotional, and sleep disturbances. Data for 1 H-MR spectroscopy recorded in five normal, age-matched, control volunteers, who were previously screened to exclude previous head injuries, were used for comparison. Semiquantitative analysis of NAA relative to creatine (Cr)-and choline (Cho)-containing compounds was performed from proton spectra obtained with a 3-T magnetic resonance system. RESULTS: Regarding the values of the NAA-to-Cr ratio (2.21 Ϯ 0.11) recorded in control patients, singly concussed athletes, at 3 days after the concussion, showed a decrease of 18.5% (1.80 Ϯ 0.04; P Ͻ 0.001). Only a modest 3% recovery was observed at 15 days (1.88 Ϯ 0.1; P Ͻ 0.001); at 30 days postinjury, the NAA-to-Cr ratio was 2.15 Ϯ 0.1, revealing full metabolic recovery with values not significantly different from those of control patients. These patients declared complete resolution of symptoms at the time of the 3-day study. The three patients who had a second concussive injury before the 15-day study showed an identical decrease of the NAA-to-Cr ratio at 3 days (1.78 Ϯ 0.08); however, at 15 days after the second injury, a further diminution of the NAA-to-Cr ratio occurred (1.72 Ϯ 0.07; P Ͻ 0.05 with respect to singly concussed athletes). At 30 days, the NAAto-Cr ratio was 1.82 Ϯ 0.1, and at 45 days postinjury, the NAA-to-Cr ratio showed complete recovery (2.07 Ϯ 0.1; not significant with respect to control patients). This group of patients declared a complete resolution of symptoms at the time of the 30-day study. CONCLUSION: Results of this pilot study carried out in a cohort of singly and doubly concussed athletes, examined by 1 H-MR spectroscopy for their NAA cerebral content at different time points after concussive events, demonstrate that also in humans, concussion opens a temporal window of brain metabolic imbalance, the closure of which does not coincide with resolution of clinical symptoms. The recovery of brain metabolism is not linearly related to time. A second concussive event prolonged the time of NAA normalization by 15 days. Although needing confirmation in a larger group of patients, these results show that NAA measurement by 1 H-MR spe...

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Section: Use Of 1 H-mr Spectroscopy In the Evaluation Of Concussionmentioning

confidence: 93%

Temporal Window of Metabolic Brain Vulnerability to Concussion

et al. 2008

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“…To date, only few studies have examined more than 25 subjects [5,[12][13][14][35][36][37][38][39][40][41][42]. Similarly, in most of the spectroscopic studies reported so far, however, subjects have been studied only when medical conditions were stabilized and, with some exception [6,11,14,43] the time of the spectroscopic examination varied greatly (a few days to several months) even in the same study [13].…”

Section: Clinical Studiesmentioning

confidence: 96%

“…Finally, Shutter et al [61], performing a prospective longitudinal MRSI study in adult TBI patients, noted that NAA/Cr ratio from the corpus callosum was most useful for long-term outcome prediction, while Nakabayashi [38] and Signoretti [62] showed the recovery of NAA levels in patients with favorable outcomes.…”

Section: Clinical Studiesmentioning

confidence: 96%

1H-MR Spectroscopy in Traumatic Brain Injury

et al. 2010

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Traumatic brain injury (TBI) is a common cause of neurological damage and disability. Conventional imaging (CT scan or MRI) is highly sensitive in detecting lesions and provides important clinical information regarding the need for acute intervention. However, abnormalities detected by CT scan or conventional MRI have limited importance in the classification of the degree of clinical severity and in predicting patients' outcome. This can be explained by the widespread microscopic tissue damage occurring after trauma, which is not observable with the conventional structural imaging methods. Advances in neuroimaging over the past two decades have greatly helped in the clinical care and management of patients with TBI. The advent of newer and more sensitive imaging techniques is now being used to better characterize the nature and evolution of injury and the underlying mechanisms that lead to progressive neurodegeneration, recovery or subsequent plasticity. This review will describe the role of proton magnetic resonance spectroscopic (MRS), an advanced MRI technique as related to its use in TBI. Proton MRS is a noninvasive approach that acquires metabolite information reflecting neuronal integrity and function from multiple brain regions and allows to assess clinical severity and to predict disease outcome.

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“…Controls show more of a bilateral stepwise increase in activation in response to processing load increases (2-back >1-back, BA 8 and 46; 3-back> 2-back, BA 6, 10, and 40). different injury to assessment intervals used [48][49][50]. However, Vagnozzi et al [51] recently reported reduced NAA/Creatine ratio in 13 individuals studied within 3 days of a sports concussion.…”

Section: Functional Imagingmentioning

confidence: 99%

Imaging of Traumatic Brain Injury

Zagorchev¹,

McAllister²

2015

Imaging of Traumatic Brain Injury

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Traumatic brain injury (TBI) represents an enormous public health challenge and is often associated with life long neurobehavioral sequelae in survivors. Several factors including higher percentages of individuals surviving TBI, as well as increasing concern about potential long term sequelae of even relatively mild injuries is changing the role of neuroimaging in the management of this condition. Historically the role has been the detection and acute management of lifethreatening complications requiring surgical intervention. However there is an emerging need for neuroimaging biomarkers that would facilitate detection of milder injuries, allow recovery trajectory monitoring, and identify those at risk for poor functional outcome and disability. This paper reviews the current status of different neuroimaging techniques in TBI and outlines some of the challenges involved in moving towards an expanded role in these domains.

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Neural injury and recovery near cortical contusions: a clinical magnetic resonance spectroscopy study

Abstract: Metabolic depression reflecting neural injury was apparent in subjacent normal-appearing white matter at 1 week after cortical contusion; this had normalized substantially at 1 month.

Cited by 36 publications

References 39 publications

Temporal Window of Metabolic Brain Vulnerability to Concussion

Temporal Window of Metabolic Brain Vulnerability to Concussion

1H-MR Spectroscopy in Traumatic Brain Injury

Imaging of Traumatic Brain Injury

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