Neuronal metabolic changes in the cortical region after subcortical infarction: a proton MR spectroscopy study

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 69; no. 2; pp. 222 - 227
• Main Authors: Kang, Dong-Wha, Roh, Jae-Kyu, Lee, Yong-Seok, Song, In Chan, Yoon, Byung-Woo, Chang, Kee-Hyun
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.08.2000; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Aged; Aged, 80 and over; Aphasia; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Biological and medical sciences; Cerebral Angiography; Cerebral Cortex - blood supply; Cerebral Cortex - diagnostic imaging; Cerebral Cortex - metabolism; Cerebral Cortex - pathology; cerebral infarction; Cerebral Infarction - diagnosis; Cerebral Infarction - metabolism; Creatine - metabolism; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Medical imaging; Medical sciences; Metabolism; Metabolites; Middle Aged; Neurology; Neurons - metabolism; Patients; Phosphocreatine - metabolism; Prospective Studies; Spectrum analysis; Studies; Tomography, Emission-Computed, Single-Photon; Tropical medicine; Vascular diseases and vascular malformations of the nervous system; Human; Cerebral infarction; Nervous system diseases; Cerebral cortex; Pathophysiology; Cardiovascular disease; Exploration; NMR spectrometry; Metabolism; Cerebral disorder; Vascular disease; Neuron; Central nervous system disease; Proton; Subcortex; Cerebrovascular disease
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.69.2.222

OBJECTIVES To investigate whether proton magnetic resonance spectroscopy (1H MRS) can detect neuronal metabolic changes in the cortical region in patients with cortical dysfunction after subcortical infarction. METHODS Fifteen patients with subcortical large (diameter⩾20 mm) infarcts were studied; nine patients with cortical dysfunction (group A), and six without (group B). Seven patients with lacunar infarction served as controls. Infarct volume was measured on T2 weighted images with an image analyser. 1H MRS data were obtained in three regions; high signal intensity area on T2 weighted image, overlying cortex with a normal T2 MRI appearance, and contralateral homologous cortical region. RESULTS Infarct volume was not different between groups A and B. N-acetylaspartate (NAA)/creatine+phosphocreatine (Cr) ratios in the cortical region overlying subcortical infarcts in group A were significantly lower than those in group B and the control group (p=0.002). The NAA/Cr ratios in the overlying cortex were significantly lower than those in the contralateral normal cortex in group A on the initial (p=0.015) and follow up (p=0.028) 1H MRS, but these differences were not found in group B and the control group. CONCLUSIONS The results support the idea that the cerebral cortex is a responsible location for cortical dysfunction after subcortical infarctions.1H MRS can be used as a sensitive method for the detection of a neuronal metabolic damage, which is not demonstrated by conventional MRI.