This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wardlaw, J. M. Articles by Lewis, S. C. Search for Related Content PubMed PubMed Citation Articles by Wardlaw, J. M. Articles by Lewis, S. C. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB (L)-ASPARTIC ACID CHOLINE BITARTRATE CHOLINE CHLORIDE Medline Plus Health Information MRI Scans

(Stroke. 1998;29:1618-1624.)
© 1998 American Heart Association, Inc.

Original Contributions

Studies of Acute Ischemic Stroke With Proton Magnetic Resonance Spectroscopy

Relation Between Time From Onset, Neurological Deficit, Metabolite Abnormalities in the Infarct, Blood Flow, and Clinical Outcome

Joanna M. Wardlaw, MRCP, FRCR, MD; Ian Marshall, MA, PhD; Jim Wild, MA, MSc; Martin S. Dennis, MBBS, FRCP, MD; Jim Cannon, BSc, (Hons), DCR; Stephanie C. Lewis, MSc, BSc

From the Departments of Clinical Neurosciences (J.M.W., M.S.D., J.C., S.C.L.) and Medical Physics (I.M., J.W.), University of Edinburgh, Western General Hospital, Edinburgh, Scotland.

Correspondence to Dr J.M. Wardlaw, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. E-mail jmw{at}skull.dcn.ed.ac.uk

Background and Purpose—Proton magnetic resonance spectroscopy (MRS) can be used to study metabolite abnormalities in the brains of stroke patients. We have used it to examine the relations between the metabolites in the infarct (N-acetylaspartate [NAA] and lactate) and the time lapse from stroke to MRS, the presenting neurological deficit, infarct size and swelling (on MRI), blood flow to the infarct (estimated by transcranial Doppler ultrasound), and clinical outcome.

Methods—Patients with symptoms of a moderate to large cortical infarct underwent serial proton MRS (Siemens 1.5 Magnetom) within 4 days, from 5 to 10, and from 11 to 35 days after the stroke. A long echo time PRESS single voxel or chemical shift imaging acquisition was used. Transcranial Doppler ultrasound was performed daily in the first week and twice per week thereafter until the final MRS. Clinical features and baseline demographic data were collected independently by a stroke physician and 6-month outcome by postal questionnaire.

Results—Fifty patients underwent at least 1 MRS examination. Reduced NAA in the infarct within the first 4 days was related to the clinical stroke syndrome, more extensive infarction, more severely reduced blood supply to the infarct, and the presence of lactate. The presence of lactate was related to large infarcts and reduced NAA. Swelling in the infarct was most closely associated with large infarcts and reduced blood supply but not reduced NAA or the presence of lactate. Clinical outcome was most closely related to the extent of the infarct (more than to the clinical syndrome)-the larger the infarct the worse the outcome-but not to the metabolite concentrations alone.

Conclusions—The reduction in NAA (but not the presence of lactate) in a visible infarct was related to the reduction in blood flow to the infarct, which in turn was related to infarct extent and clinical outcome.

Key Words: cerebral infarct • lactate • magnetic resonance imaging • middle cerebral artery • N-acetylaspartate • spectroscopy, nuclear magnetic resonance • stroke • ultrasound, Doppler, transcranial

This article has been cited by other articles:

				S. Munoz Maniega, V. Cvoro, F. M. Chappell, P. A. Armitage, I. Marshall, M. E. Bastin, and J. M. Wardlaw Changes in NAA and lactate following ischemic stroke: A serial MR spectroscopic imaging study Neurology, December 9, 2008; 71(24): 1993 - 1999. [Abstract] [Full Text] [PDF]

				T. Bartsch, K. Alfke, S. Wolff, A. Rohr, O. Jansen, and G. Deuschl Focal MR spectroscopy of hippocampal CA-1 lesions in transient global amnesia Neurology, March 25, 2008; 70(13): 1030 - 1035. [Abstract] [Full Text] [PDF]

				M. Gwak, P. Park, K. Kim, K. Lim, S. Jeong, C. Baek, and J. Lee The Effects of Dantrolene on Hypoxic-Ischemic Injury in the Neonatal Rat Brain Anesth. Analg., January 1, 2008; 106(1): 227 - 233. [Abstract] [Full Text] [PDF]

				R. M. Douglas, N. Miyasaka, K. Takahashi, A. Latuszek-Barrantes, G. G. Haddad, and H. P. Hetherington Chronic intermittent but not constant hypoxia decreases NAA/Cr ratios in neonatal mouse hippocampus and thalamus Am J Physiol Regulatory Integrative Comp Physiol, March 1, 2007; 292(3): R1254 - R1259. [Abstract] [Full Text] [PDF]

				W. Block, F. Jessen, F. Traber, S. Flacke, C. Manka, R. Lamerichs, E. Keller, R. Heun, and H. Schild Regional N-Acetylaspartate Reduction in the Hippocampus Detected With Fast Proton Magnetic Resonance Spectroscopic Imaging in Patients With Alzheimer Disease Arch Neurol, May 1, 2002; 59(5): 828 - 834. [Abstract] [Full Text] [PDF]

				R. H.C. Bisschops, L.J. Kappelle, W. P.T.M. Mali, and J. van der Grond Hemodynamic and Metabolic Changes in Transient Ischemic Attack Patients: A Magnetic Resonance Angiography and 1H-Magnetic Resonance Spectroscopy Study Performed Within 3 Days of Onset of a Transient Ischemic Attack Stroke, January 1, 2002; 33(1): 110 - 115. [Abstract] [Full Text] [PDF]

				M. Kobayashi, H. Takayama, S. Suga, B. Mihara, G. A. Rosenberg, and W. M. Brooks Longitudinal Changes of Metabolites in Frontal Lobes After Hemorrhagic Stroke of Basal Ganglia: A Proton Magnetic Resonance Spectroscopy Study Editorial Comment: A Proton Magnetic Resonance Spectroscopy Study Stroke, October 1, 2001; 32(10): 2237 - 2245. [Abstract] [Full Text] [PDF]

				R. L. Levine One-Stop Shopping: Stroke Questions Further Answered With Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 555 - 556. [Full Text] [PDF]

				D. R. Rutgers, C. J. M. Klijn, L. J. Kappelle, B. C. Eikelboom, A. C. van Huffelen, and J. van der Grond Sustained Bilateral Hemodynamic Benefit of Contralateral Carotid Endarterectomy in Patients With Symptomatic Internal Carotid Artery Occlusion Stroke, March 1, 2001; 32(3): 728 - 734. [Abstract] [Full Text] [PDF]

				C. J. M. Klijn, L. J. Kappelle, J. van der Grond, A. Algra, C. A. F. Tulleken, and J. van Gijn Magnetic Resonance Techniques for the Identification of Patients With Symptomatic Carotid Artery Occlusion at High Risk of Cerebral Ischemic Events Stroke, December 1, 2000; 31(12): 3001 - 3007. [Abstract] [Full Text] [PDF]

				J. M. Wild, J. M. Wardlaw, I. Marshall, and C. P. Warlow N-Acetylaspartate Distribution in Proton Spectroscopic Images of Ischemic Stroke : Relationship to Infarct Appearance on T2-Weighted Magnetic Resonance Imaging Stroke, December 1, 2000; 31(12): 3008 - 3014. [Abstract] [Full Text] [PDF]

				M. W. Parsons, T. Li, P. A. Barber, Q. Yang, D. G. Darby, P. M. Desmond, R. P. Gerraty, B. M. Tress, and S. M. Davis Combined 1H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome Neurology, August 22, 2000; 55(4): 498 - 506. [Abstract] [Full Text] [PDF]

				A. C. Pereira, D. E. Saunders, V. L. Doyle, J. M. Bland, F. A. Howe, J. R. Griffiths, and M. M. Brown Measurement of Initial N-Acetyl Aspartate Concentration by Magnetic Resonance Spectroscopy and Initial Infarct Volume by MRI Predicts Outcome in Patients With Middle Cerebral Artery Territory Infarction Stroke, August 1, 1999; 30(8): 1577 - 1582. [Abstract] [Full Text] [PDF]