Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Metabolic Changes in Pericontusional Edematous Areas in Mild Head Injury Evaluated by Proton MRS

경도 두부외상 환자에서 뇌좌상주위 부종영역에서의 자기공명분광법을 이용한 대사변화

  • Hong, Sang-Su (Department of Neurosurgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Son, Byung-Chul (Department of Neurosurgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cho, Byung Gil (Department of Diagnostic Radiology, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Euy-Nyeng (Department of Diagnostic Radiology, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Bum-Soo (Department of Diagnostic Radiology, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Chun-Kum (Department of Neurosurgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choe, Bo-Young (Department of Bio-Medical Engineering, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Moon-Chan (Department of Neurosurgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Joon-Ki (Department of Neurosurgery, Kangnam St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 홍상수 (가톨릭대학교 의과대학 강남성모병원 신경외과학교실) ;
  • 손병철 (가톨릭대학교 의과대학 강남성모병원 신경외과학교실) ;
  • 최병길 (가톨릭대학교 의과대학 강남성모병원 진단방사선과학교실) ;
  • 김의녕 (가톨릭대학교 의과대학 강남성모병원 진단방사선과학교실) ;
  • 김범수 (가톨릭대학교 의과대학 강남성모병원 진단방사선과학교실) ;
  • 박춘근 (가톨릭대학교 의과대학 강남성모병원 신경외과학교실) ;
  • 최보영 (가톨릭대학교 의과대학 강남성모병원 의공학교실) ;
  • 김문찬 (가톨릭대학교 의과대학 강남성모병원 신경외과학교실) ;
  • 강준기 (가톨릭대학교 의과대학 강남성모병원 신경외과학교실)
  • Received : 2000.06.05
  • Accepted : 2000.10.31
  • Published : 2000.09.28
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Abstract

Objectives : In order to evaluate the metabolic changes associated with pericontusional edematous area in mild head injury, proton magnetic resonance spectroscopy(1H-MRS) was performed in mild head injury patients (initial GCS score 13-15) with focal brain contusion. Methods : Seven head injury patients with initial GCS 13-15(3 males and 4 females : age range 15-65 years, mean age 33 years) have underwent 1H-MRS evaluations. The patients were examined within 7 days after injury(n=7) and 2 months after injury(n=5). The region of interest(ROI) was selected in the edematous area adjacent to traumatic brain contusion upon T2-weighted MR images and a corresponding region of the contralateral hemisphere (ROC, region of contralateral corresponding hemisphere) was examined as well. The metabolic ratios of NAA/Cr and lactate/Cr were compared between ROIs, ROCs and control values. Results : In initial NAA/Cr ratios, the values of ROIs were significantly lower than those of the controls(p=0.009), but there was no difference either between ROIs and ROCs(p=0.410) or between ROCs of patients and the control (p=0.199). In lactate/Cr ratios, the ROIs in all seven patients and the ROCs in two showed increased lactate signals. The lactate/Cr ratios of the ROIs were significantly elevated as compared to those of the ROCs(p=0.02) and the control(p=0.015). In two months follow-up, lactate signals were absent or significantly reduced(p=0.015). In no patients, clinical or radiological deterioration has been observed. Conclusion : Our 1H-MRS results demonstrate that there are significant ischemic changes in pericontusional edematous areas as indicated by elevated lactate signals in the patients with mild head injury. But there were no consistent neural loss or dysfunction in these area. There findings suggest that pericontusional edematous areas can be vulnerable to secondary brain insults even in the patients with mild head injury.

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