Longitudinal changes of metabolites in frontal lobes after hemorrhagic stroke of basal ganglia: a proton magnetic resonance spectroscopy study

• Published in: Stroke (1970) 2001-10, Vol.32 (10), p.2237-2245
• Main Authors: Kobayashi, M, Takayama, H, Suga, S, Mihara, B
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Basal Ganglia Hemorrhage - complications; Basal Ganglia Hemorrhage - diagnosis; Basal Ganglia Hemorrhage - metabolism; Basal Ganglia Hemorrhage - therapy; Creatine - metabolism; Disease Progression; Female; Frontal Lobe - metabolism; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Middle Aged; Predictive Value of Tests; Severity of Illness Index; Stroke - complications; Stroke - diagnosis; Stroke - metabolism; Stroke - therapy; Treatment Outcome
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/hs1001.096621

We investigated serial metabolic changes in frontal lobes of patients with deep intracerebral hemorrhage (ICH) to examine the correlation between N-acetylaspartate (NAA) and degree of motor impairment or clinical outcome. - Twenty patients with deep ICH were examined with proton magnetic resonance spectroscopy with the application of a multivoxel method (1 voxel=10x10x20 mm; 64 voxels). NAA/creatine ratios in the white matter of the primary motor and premotor areas on both sides were measured sequentially: within 48 hours, at 2 weeks, and 1 month after onset. The National Institutes of Health Stroke Scale and Barthel Index for disability were measured for each patient. - In the primary motor area on the affected side, where the hematoma did not extend, the NAA/creatine ratio decreased sequentially. At 48 hours and 2 weeks after onset, a negative correlation was detected between NAA/creatine and hematoma volume, but there was no correlation 1 month later. At 2 weeks, NAA/creatine correlated negatively with motor impairment (r=-0.750), and there was a significant correlation with clinical outcome as early as 2 weeks after onset (r=0.954). These sequential changes of NAA/creatine varied according to patients' long-term clinical outcome. Patients with poor outcome demonstrated notable reduction of NAA/creatine over the bilateral frontal lobes. - The delayed gradual reduction of NAA/creatine ratio in the frontal lobes correlates with motor deficit and clinical outcome after deep ICH, suggesting that the neural networks in the frontal lobe could be important for recovery.