title: Decrease in N-acetylaspartate following concussion may be coupled to decrease in creatine.
abstract: OBJECTIVE
  To assess the time course changes in N-acetylaspartate (NAA) and creatine (Cr) levels in the brain of athletes who suffered a sport-related concussion.
  
  
  METHODS
  Eleven nonconsecutive athletes with concussive head injury and 11 sex- and age-matched control volunteers
  
  
  METHODS
  : At 3, 15, 30, and 45 days postinjury, athletes were examined by proton magnetic resonance spectroscopy for the determination of NAA, Cr, and choline (Cho) levels. Proton magnetic resonance spectroscopic data recorded for the control group were used for comparison.
  
  
  RESULTS
  Compared with controls (2.18 ± 0.19), athletes showed an increase in the NAA/Cr ratio at 3 (2.71 ± 0.16; P < .01) and 15 (2.54 ± 0.21; P < .01) days postconcussion, followed by a decrease and subsequent normalization at 30 (1.95 ± 0.16, P < .05) and 45 (2.17 ± 0.20; P < .05) days postconcussion. The NAA/Cho ratio decreased at 3, 15, and 30 days postinjury (P < .01 compared with controls), with no differences observed in controls at 45 days postconcussion. Compared with controls, significant increase in the Cho/Cr ratio after 3 (+33%, P < .01) and 15 (+31.5%, P < .01) days postinjury was observed whereas no differences were recorded at 30 and 45 days postinjury.
  
  
  CONCLUSIONS
  This cohort of athletes indicates that concussion may cause concomitant decrease in cerebral NAA and Cr levels. This provokes longer time for normalization of metabolism, as well as longer time for resolution of concussion-associated clinical symptoms.
authors.affiliation: Division of Neurotraumatology and Neuroradiology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vagnozzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Signoretti
authors.forename: Roberto
authors.initials: R
authors.lastname: Floris
authors.forename: Simone
authors.initials: S
authors.lastname: Marziali
authors.forename: Massimo
authors.initials: M
authors.lastname: Manara
authors.forename: Angela M
authors.initials: AM
authors.lastname: Amorini
authors.forename: Antonio
authors.initials: A
authors.lastname: Belli
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Pietro
authors.forename: Serafina
authors.initials: S
authors.lastname: Dʼurso
authors.forename: Francesco S
authors.initials: FS
authors.lastname: Pastore
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lazzarino
authors.forename: Barbara
authors.initials: B
authors.lastname: Tavazzi
mesh_terms: D000293:Adolescent; D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis / Q000378:metabolism; D001265:Athletic Injuries / Q000175:diagnosis / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D001924:Brain Concussion / Q000175:diagnosis* / Q000378:metabolism*; D016022:Case-Control Studies; D002794:Choline / Q000032:analysis / Q000378:metabolism*; D015331:Cohort Studies; D003401:Creatine / Q000032:analysis / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D020127:Recovery of Function / Q000502:physiology; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013177:Sports; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline