title: Metabolic changes in patients with aneurysmal subarachnoid hemorrhage apart from perfusion deficits: neuronal mitochondrial injury?
abstract: OBJECTIVE
  Neuronal damage in aSAH apart from perfusion deficits has been widely discussed. We aimed to test if cerebral injury occurs in aSAH independently from visible perfusion deficit by measuring cerebral metabolites in patients with aSAH without infarction or impaired perfusion.
  
  
  METHODS
  We performed 3T MR imaging including (1)H-MR spectroscopy, DWI, and MR perfusion in 58 patients with aSAH and 11 age-matched and sex-matched control patients with incidental aneurysm. We compared changes of NAA, Cho, Glx, Lac, and Cr between all patients with aSAH and controls, between patients with and without visible perfusion deficit or infarction and controls, and between patients with and without visible perfusion deficit or infarction by using the Wilcoxon signed-rank test.
  
  
  RESULTS
  We found that NAA significantly (P < .005) decreased in all patients with aSAH. Cho was significantly increased in all patients compared with controls (P < .05). In patients without impaired perfusion or infarction, Glx was significantly decreased compared with both controls (P = .005) and patients with impaired perfusion or infarction (P = .006).
  
  
  CONCLUSIONS
  The significant decrease of NAA and Glx in patients with aSAH but without impaired perfusion or infarction strongly suggests global metabolic changes independent from visible perfusion deficits that might reflect neuronal mitochondrial injury. Further, impaired perfusion in aSAH seems to induce additional metabolic changes from increasing neuronal stress that might, to some extent, mask the global metabolic changes.
authors: Institute of Neuroradiology.
authors: M
authors: M
authors: Wagner
authors: A
authors: A
authors: Jurcoane
authors: C
authors: C
authors: Hildebrand
authors: E
authors: E
authors: Güresir
authors: H
authors: H
authors: Vatter
authors: F E
authors: FE
authors: Zanella
authors: J
authors: J
authors: Berkefeld
authors: U
authors: U
authors: Pilatus
authors: E
authors: E
authors: Hattingen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001921:Brain / Q000378:metabolism* / Q000473:pathology; D001930:Brain Injuries / Q000378:metabolism* / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000378:metabolism / Q000473:pathology; D005260:Female; D005973:Glutamine / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000378:metabolism / Q000473:pathology*; D009474:Neurons / Q000378:metabolism* / Q000473:pathology; D011522:Protons; D013345:Subarachnoid Hemorrhage / Q000378:metabolism* / Q000473:pathology
chemical_list: D015415:Biomarkers; D011522:Protons; D005973:Glutamine; D001224:Aspartic Acid; C000179:N-acetylaspartate