title: Longitudinal changes of metabolites in frontal lobes after hemorrhagic stroke of basal ganglia: a proton magnetic resonance spectroscopy study.
abstract: OBJECTIVE
  We investigated serial metabolic changes in frontal lobes of patients with deep intracerebral hemorrhage (ICH) to examine the correlation between N-acetylaspartate (NAA) and degree of motor impairment or clinical outcome.
  
  
  METHODS
  - Twenty patients with deep ICH were examined with proton magnetic resonance spectroscopy with the application of a multivoxel method (1 voxel=10x10x20 mm; 64 voxels). NAA/creatine ratios in the white matter of the primary motor and premotor areas on both sides were measured sequentially: within 48 hours, at 2 weeks, and 1 month after onset. The National Institutes of Health Stroke Scale and Barthel Index for disability were measured for each patient.
  
  
  RESULTS
  - In the primary motor area on the affected side, where the hematoma did not extend, the NAA/creatine ratio decreased sequentially. At 48 hours and 2 weeks after onset, a negative correlation was detected between NAA/creatine and hematoma volume, but there was no correlation 1 month later. At 2 weeks, NAA/creatine correlated negatively with motor impairment (r=-0.750), and there was a significant correlation with clinical outcome as early as 2 weeks after onset (r=0.954). These sequential changes of NAA/creatine varied according to patients' long-term clinical outcome. Patients with poor outcome demonstrated notable reduction of NAA/creatine over the bilateral frontal lobes.
  
  
  CONCLUSIONS
  - The delayed gradual reduction of NAA/creatine ratio in the frontal lobes correlates with motor deficit and clinical outcome after deep ICH, suggesting that the neural networks in the frontal lobe could be important for recovery.
authors.affiliation: Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Japan. mkobayas@caregroup.harvard.edu
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.forename: H
authors.initials: H
authors.lastname: Takayama
authors.forename: S
authors.initials: S
authors.lastname: Suga
authors.forename: B
authors.initials: B
authors.lastname: Mihara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D020145:Basal Ganglia Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism* / Q000628:therapy; D003401:Creatine / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D005625:Frontal Lobe / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine