TY - JOUR
T1 - Altered white matter metabolism in delayed neurologic sequelae after carbon monoxide poisoning
T2 - A proton magnetic resonance spectroscopic study
AU - Kuroda, Hiroshi
AU - Fujihara, Kazuo
AU - Mugikura, Shunji
AU - Takahashi, Shoki
AU - Kushimoto, Shigeki
AU - Aoki, Masashi
N1 - Funding Information:
Dr. Mugikura has received research support from a grant-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology of Japan. Dr. Takahashi has received research support from grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology of Japan. Dr. Kushimoto has received research support from grants-in-aid for scientific research from the Ministry of Education, Science, and Technology of Japan. Dr. Aoki has received research support from grants-in-aid for scientific research from the Ministry of Education, Science and Technology of Japan, and the Ministry of Health, Labor and Welfare of Japan.
Funding Information:
We thank the staff of the Tohoku University Hospital Emergency Medical Center for recruiting and treating patients. We would like to thank Enago ( www.enago.jp ) for the English language review. This study was supported by a grant-in-aid for scientific research (grant number 24592728 ) from the Ministry of Education, Science and Technology of Japan .
Publisher Copyright:
© 2015 Elsevier B.V.
PY - 2016/1/15
Y1 - 2016/1/15
N2 - Proton magnetic resonance spectroscopy (1H-MRS) was recently used to examine altered metabolism in the white matter (WM) of patients experiencing carbon monoxide (CO) poisoning; however, only a small number of patients with delayed neurologic sequelae (DNS) were analyzed. We aimed to detect altered metabolism in the WM of patients with DNS using 1H-MRS; to explore its clinical relevance in the management of patients experiencing CO poisoning. Patients experiencing acute CO poisoning underwent 1H-MRS and cerebrospinal fluid (CSF) examination within 1 week and at 1 month after acute poisoning. Metabolites including choline-containing compounds (Cho), creatine (Cr), N-acetylaspartate (NAA), and lactate were measured from the periventricular WM. Myelin basic protein (MBP) concentrations were measured in CSF. Fifty-two patients experiencing acute CO poisoning (15 with DNS, 37 without DNS; median age, 49 years; 65% males) underwent 1H-MRS. Within 1 week, NAA/Cr ratios, reflecting neuroaxonal viability, were lower in patients with DNS than in those without DNS (P < 0.05). At 1 month, when 9 of 15 patients (60%) developed DNS, Cho/Cr ratios were higher, and NAA/Cr and NAA/Cho ratios lower in patients with DNS (P = 0.0001, < 0.0001, and < 0.0001, respectively), indicating increased membrane metabolism and decreased neuroaxonal viability. 1H-MRS parameter abnormalities correlated with the elevation of MBP in CSF. The presence of a lactate peak was a predictor for a poor long-term outcome. 1H-MRS within 1 week may be useful for predicting DNS development; 1H-MRS at 1 month may be useful for discriminating patients with DNS and predicting long-term outcomes.
AB - Proton magnetic resonance spectroscopy (1H-MRS) was recently used to examine altered metabolism in the white matter (WM) of patients experiencing carbon monoxide (CO) poisoning; however, only a small number of patients with delayed neurologic sequelae (DNS) were analyzed. We aimed to detect altered metabolism in the WM of patients with DNS using 1H-MRS; to explore its clinical relevance in the management of patients experiencing CO poisoning. Patients experiencing acute CO poisoning underwent 1H-MRS and cerebrospinal fluid (CSF) examination within 1 week and at 1 month after acute poisoning. Metabolites including choline-containing compounds (Cho), creatine (Cr), N-acetylaspartate (NAA), and lactate were measured from the periventricular WM. Myelin basic protein (MBP) concentrations were measured in CSF. Fifty-two patients experiencing acute CO poisoning (15 with DNS, 37 without DNS; median age, 49 years; 65% males) underwent 1H-MRS. Within 1 week, NAA/Cr ratios, reflecting neuroaxonal viability, were lower in patients with DNS than in those without DNS (P < 0.05). At 1 month, when 9 of 15 patients (60%) developed DNS, Cho/Cr ratios were higher, and NAA/Cr and NAA/Cho ratios lower in patients with DNS (P = 0.0001, < 0.0001, and < 0.0001, respectively), indicating increased membrane metabolism and decreased neuroaxonal viability. 1H-MRS parameter abnormalities correlated with the elevation of MBP in CSF. The presence of a lactate peak was a predictor for a poor long-term outcome. 1H-MRS within 1 week may be useful for predicting DNS development; 1H-MRS at 1 month may be useful for discriminating patients with DNS and predicting long-term outcomes.
KW - Carbon monoxide poisoning
KW - Delayed neurologic sequelae
KW - Myelin basic protein
KW - Outcome
KW - Proton magnetic resonance spectroscopy
KW - White matter
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U2 - 10.1016/j.jns.2015.12.006
DO - 10.1016/j.jns.2015.12.006
M3 - Article
C2 - 26723994
AN - SCOPUS:84955456389
SN - 0022-510X
VL - 360
SP - 161
EP - 169
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
ER -