gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Magnetic resonance markers of bihemispheral neuronal metabolic dysfunction in patients with unilateral ICA occlusion

Meeting Abstract

  • D. Horínek - Neurochirurgicka klinika, 1. lekarska fakulta, Karlova Univerzita v Praze, Ceska Republika; Klinik für Neurochirurgie, Philipps Universität, Marburg, Deutschland; International Clinical Research Center, nemocnice U sv. Anny, Brno, Ceska Republika
  • A. Malucelli - International Clinical Research Center, nemocnice U sv. Anny, Brno, Ceska Republika; Neurochirurgicka klinika, nemocnice Usti nad Labem, Ceska Republika
  • T. Škoch - International Clinical Research Center, nemocnice U sv. Anny, Brno, Ceska Republika; Oddeleni klinicke a experimentalni spektroskopie, IKEM, Praha, Ceska Republika
  • A. Tomek - Neurologicka klinika FN Motol, Praha, Ceska Republika
  • B. Urbanová - Neurologicka klinika FN Motol, Praha, Ceska Republika
  • L. Martinkovič - Neurologicka klinika FN Motol, Praha, Ceska Republika
  • S. Ostrý - Neurochirurgicka klinika, 1. lekarska fakulta, Karlova Univerzita v Praze, Ceska Republika
  • M. Mohapl - Neurochirurgicka klinika, 1. lekarska fakulta, Karlova Univerzita v Praze, Ceska Republika
  • I. Buksakowská - International Clinical Research Center, nemocnice U sv. Anny, Brno, Ceska Republika; Klinika zobrazovacich metod, FN Motol, Praha, Ceska Republika
  • D. Netuka - Neurochirurgicka klinika, 1. lekarska fakulta, Karlova Univerzita v Praze, Ceska Republika
  • J. Hort - Neurologicka klinika FN Motol, Praha, Ceska Republika
  • J. Vrána - Radiologicke oddeleni, Ustredni vojenska nemocnice, Praha, Ceska Republika
  • J. Šroubek - Neurochirurgicka klinika, nemocenice Na Homolce, Praha, Ceska Republika
  • C. Nimsky - Klinik für Neurochirurgie, Philipps Universität, Marburg, Deutschland
  • V. Beneš - Neurochirurgicka klinika, 1. lekarska fakulta, Karlova Univerzita v Praze, Ceska Republika

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.15.06

DOI: 10.3205/12dgnc138, URN: urn:nbn:de:0183-12dgnc1388

Published: June 4, 2012

© 2012 Horínek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: To evaluate cerebral hemodynamic, metabolic and anatomic changes occurring in patients with unilateral occlusion of internal carotid artery (ICA).

Methods: Twenty-nine patients with unilateral occlusion of ICA, either asymptomatic or with a history of minor stroke (modified Rankin scale < 2) and twenty age and sex matched healthy subjects were included in the study. Patients with contralateral ICA stenosis and major stroke were excluded. In all patients and controls we performed a 1H-MRS study, a semi-automated hippocampal volumetry in T1-weighted scans and Transcranial Doppler (TCD) examination with calculation of Breath Holding Index (BHI). Metabolic, anatomic and hemodynamic features were compared in the two groups.

Results: The concentrations of N-Acetylasapartate (NAA) and the ratio NAA/Choline resulted to be significantly lower in both hemispheres of enrolled patients compared with controls, while no statistically significant correlations were found for Lactate, Creatine and Choline alone. The volume of hippocampus resulted significantly reduced at both sides in patients in comparison with healthy subjects. No statistically significant differences in NAA concentration and hippocampal volume were found between the two hemispheres of examined patients, thus suggesting a bilateral impairment.

Conclusions: Patients with occlusion of ICA present reduction of NAA in the white matter of both hemispheres and bilateral atrophy of hippocampus. The alteration of hemodynamics alone cannot explain these changes. Lactate is not a reliable marker of metabolic impairment in the chronic stage of ICA occlusion. Our results support the hypothesis that the neuronal dysfunction in ICA disease results from the impairment of microcirculation rather than from embolic or hemodynamic pathology.