title: Reversible Cerebral Metabolism Changes Using Proton Magnetic Resonance Spectroscopy in a Patient with Intracranial Dural Arteriovenous Fistula: A Case Report.
abstract: BACKGROUND
  Cerebral metabolism can be disrupted by venous congestion in patients with intracranial dural arteriovenous fistula (DAVF), which may lead to adverse neurological outcomes. However, there are no clear indicators to guide cerebral evaluation and treatment selection in cases of DAVF. We describe a patient with a DAVF whose proton magnetic resonance spectroscopy ((1)H-MRS) findings were associated with improvements in clinical status.
  
  
  METHODS
  An elderly woman with a history of myocardial infarction presented with progressive dementia, aphasia, and a severe headache. We detected a transverse-sigmoid sinus DAVF, as well as abnormal levels of lactate and N-acetylaspartic acid (NAA) in the (1)H-MRS, and successfully treated the patient using surgical sinus skeletonization. However, follow-up (1)H-MRS revealed inconsistent reversals in the levels of lactate and NAA. In addition, we calculated the NAA/creatinine ratios from before and after surgery, which revealed postoperative increases in the ratios for the left temporal, right parietal, and left parietal regions. These increases occurred concurrently with improvements in the patient's cognitive function.
  
  
  CONCLUSIONS
  (1)H-MRS may be useful for pretreatment detection of increased lactate levels, decreased NAA levels, and/or decreased NAA/creatinine ratios. These findings may indicate poorer cerebral metabolism, and show a need for more aggressive treatment. Furthermore, (1)H-MRS may be useful for evaluating the effect of conservative treatment and for indicating conversion to a more aggressive treatment.
authors.affiliation: Department of Neurosurgery, Kanto Neurosurgical Hospital, Saitama, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: ryu.bikei@twmu.ac.jp.
authors.forename: Bikei
authors.initials: B
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawamata
authors.affiliation: Department of Neurosurgery, Kanto Neurosurgical Hospital, Saitama, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Wakai
authors.affiliation: Department of Neurosurgery, Kanto Neurosurgical Hospital, Saitama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Department of Neurosurgery, Kanto Neurosurgical Hospital, Saitama, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yagi
authors.affiliation: Department of Neurosurgery, Kanto Neurosurgical Hospital, Saitama, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003401:Creatine / Q000378:metabolism; D003704:Dementia / Q000209:etiology; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D066244:Proton Magnetic Resonance Spectroscopy
chemical_list: D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D003401:Creatine
keywords: Cerebral metabolism; Dural arteriovenous fistula; N-acetylaspartic acid; Proton magnetic resonance spectroscopy