1H-magnetic resonance spectroscopy indicates damage to cerebral white matter in the subacute phase after CO poisoning.
OBJECTIVE
The authors examined whether (1)H-magnetic resonance spectroscopy (MRS) can identify damage to the centrum semiovale in the subacute phase after CO exposure.


METHODS
Subjects comprised 29 adult patients who were treated with hyperbaric oxygenation within a range of 4-95 h (mean 18.7 h) after CO exposure. Subjects were classified into three groups according to clinical behaviours: Group A, patients with transit acute symptoms only; Group P, patients with persistent neurological symptoms; and Group D, patients with 'delayed neuropsychiatric sequelae' occurring after a lucid interval. MRS of bilateral centrum semiovale was performed 2 weeks after CO inhalation for all patients and 13 healthy volunteers. The mean ratios of choline-containing compounds/creatine ((mean)Cho/Cr) and N-acetylaspartate/Cr ((mean)NAA/Cr) for bilateral centrum semiovale were calculated and compared between the three CO groups and controls. Myelin basic protein (MBP) concentration in cerebrospinal fluid was examined at 2 weeks to evaluate the degree of demyelination in patients.


RESULTS
MBP concentration was abnormal for almost all patients in Groups P and D, but was not abnormal for any Group A patients. The (mean)Cho/Cr ratios were significantly higher in Groups P and D than in Group A. No significant difference in (mean)NAA/Cr ratio was seen between the three pathological groups and controls. A significant correlation was identified between MBP and (mean)Cho/Cr ratio.


CONCLUSIONS
These results suggest that the Cho/Cr ratio in the subacute phase after CO intoxication represents early demyelination in the centrum semiovale, and can predict chronic neurological symptoms.
Department of Neurosurgery, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan. tbeppu@iwate-med.ac.jp
Takaaki
T
Beppu
Hideaki
H
Nishimoto
Shunrou
S
Fujiwara
Kaoru
K
Kudo
Katsumi
K
Sanjo
Shinsuke
S
Narumi
Hirotaka
H
Oikawa
Makoto
M
Onodera
Kuniaki
K
Ogasawara
Makoto
M
Sasaki
D001921:Brain / Q000378:metabolism / Q000503:physiopathology*; D001928:Brain Diseases, Metabolic / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D002249:Carbon Monoxide Poisoning / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D003711:Demyelinating Diseases / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006931:Hyperbaric Oxygenation; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D004676:Myelin Basic Protein / Q000134:cerebrospinal fluid; D009413:Nerve Fibers, Myelinated / Q000378:metabolism*; D011522:Protons; D013997:Time Factors
D004676:Myelin Basic Protein; D011522:Protons; D003401:Creatine; D002794:Choline