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Cerebral metabolic differences between the severe and critical hypoperfused brain
J van der Grond1, L M Ramos, B C Eikelboom
1Department of Radiology, University Hospital Utrecht, The Netherlands.
Neurology
|August 1, 1996
Summary
Severe extracranial artery stenosis can cause brain hypoperfusion and stroke. This study found decreased brain metabolism in hypoperfused areas, indicating a threshold for irreversible damage detectable by MR spectroscopic imaging.
Area of Science:
- Neurology
- Radiology
- Cerebrovascular Medicine
Background:
- Extracranial artery stenosis (>70% diameter reduction) can lead to cerebral hypoperfusion and infarction.
- Understanding the metabolic changes in non-infarcted, hypoperfused brain regions is crucial for predicting irreversible damage.
Purpose of the Study:
- To investigate the correlation between decreased brain metabolism and the level of hypoperfusion in non-infarcted areas.
- To identify potential metabolic markers detectable by MR spectroscopic imaging that indicate critical hypoperfusion.
Main Methods:
- Magnetic Resonance Imaging (MRI) and MR spectroscopic imaging were used.
- Fifty-one patients with varying degrees of cerebral infarction (none, borderzone, territory) and 14 healthy controls were studied.
Main Results:
- The N-acetylaspartate/choline (NAA/choline) ratio was significantly reduced in the symptomatic hemisphere of patients with borderzone infarcts compared to other groups.
- Patients with borderzone infarcts showed a higher incidence of cerebral lactate, suggesting anaerobic metabolism.
Conclusions:
- A critical threshold of hypoperfusion exists, below which irreversible cerebral damage may occur.
- MR spectroscopic imaging can indirectly measure this hypoperfusion by detecting metabolic changes like reduced NAA/choline ratio and increased lactate.