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. Kuroda 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. Fujihara serves on scientific advisory boards for Bayer Schering Pharma, Biogen Idec, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Chugai Pharmaceutical, Ono Pharmaceutical, Nihon Pharmaceutical, Merck Serono, Alexion Pharmaceuticals, Medimmune, and Medical Review; he has received funding for travel and speaker honoraria from Bayer Schering Pharma, Biogen Idec, Eisai Inc., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Astellas Pharma Inc., Takeda Pharmaceutical Company Limited, Asahi Kasei Medical Co., Daiichi Sankyo, and Nihon Pharmaceutical; he serves as an editorial board member of Clinical and Experimental Neuroimmunology (2009–present) and an advisory board member of Sri Lanka Journal of Neurology; he has received research support from Bayer Schering Pharma, Biogen Idec Japan, Asahi Kasei Medical, The Chemo-Sero-Therapeutic Research Institute, Teva Pharmaceutical, Mitsubishi Tanabe Pharma, Teijin Pharma, Chugai Pharmaceutical, Ono Pharmaceutical, Nihon Pharmaceutical, and Genzyme Japan; he has received research support from grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and the Ministry of Health, Welfare and Labor of Japan.
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
VL - 360
SP - 161
EP - 169
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
SN - 0022-510X
ER -