The prognostic value of multivoxel magnetic resonance spectroscopy determined metabolite levels in white and grey matter brain tissue for adverse outcome in term newborns following perinatal asphyxia

Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia by providing ratios of metabolites, such as choline (Cho), creatine (Cr), N-acetyl aspartate (NAA) and lactate (Lact) [Cho/Cr, Lact/NAA, etc.]. The purpose of this study was to quantify the separate white and grey matter metabolites in a slab cranial to the ventricles and relate these to the outcome. A standard 2D-chemical shift imaging protocol was used for measuring a transverse volume of interest located cranial to the ventricles allowing for direct comparison of the metabolites in white and grey matter brain tissue in 24 term asphyxiated newborns aged 3 to 16 days. Cho, NAA and Lact showed significant differences between four subgroups of asphyxiated infants with more and less favourable outcomes. High levels of Cho and Lact in the grey matter differentiated non-survivors from survivors (P = 0.003 and P = 0.017, respectively). In perinatal asphyxia the levels of Cho, NAA and Lact in both white and grey matter brain tissue are affected. The levels of Cho and Lact measured in the grey matter are the most indicative of survival. It is therefore advised to include grey matter brain tissue in the region of interest examined by multivoxel MR spectroscopy. aEuro cent Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia. aEuro cent Choline and lactate levels in grey matter seem the best indicators of survival. aEuro cent Both grey and white matter should be examined during spectroscopy for perinatal asphyxia

Dynamic metabolic patterns tracking neurodegeneration and gliosis following 26S proteasome dysfunction in mouse forebrain neurons

Metabolite profling is an important tool that may better capture the multiple features of neurodegeneration. With the considerable parallels between mouse and human metabolism, the use of metabolomics in mouse models with neurodegenerative pathology provides mechanistic insight and ready translation into aspects of human disease. Using 400MHz nuclear magnetic resonance spectroscopy we have carried out a temporal region-specifc investigation of the metabolome of neuron-specifc 26S proteasome knockout mice characterised by progressive neurodegeneration and Lewy-like inclusion formation in the forebrain. An early signifcant decrease in N-acetyl aspartate revealed evidence of neuronal dysfunction before cell death that may be associated with changes in brain neuroenergetics, underpinning the use of this metabolite to track neuronal health. Importantly, we show early and extensive activation of astrocytes and microglia in response to targeted neuronal dysfunction in this context, but only late changes in myo-inositol; the best established glial cell marker in magnetic resonance spectroscopy studies, supporting recent evidence that additional early neuroinfammatory markers are needed. Our results extend the limited understanding of metabolite changes associated with gliosis and provide evidence that changes in glutamate homeostasis and lactate may correlate with astrocyte activation and have biomarker potential for tracking neuroinfammation

Metabolic changes in concussed American football players during the acute and chronic post-injury phases

<p>Abstract</p> <p>Background</p> <p>Despite negative neuroimaging findings many athletes display neurophysiological alterations and post-concussion symptoms that may be attributable to neurometabolic alterations.</p> <p>Methods</p> <p>The present study investigated the effects of sports concussion on brain metabolism using ¹H-MR Spectroscopy by comparing a group of 10 non-concussed athletes with a group of 10 concussed athletes of the same age (mean: 22.5 years) and education (mean: 16 years) within both the acute and chronic post-injury phases. All athletes were scanned 1-6 days post-concussion and again 6-months later in a 3T Siemens MRI.</p> <p>Results</p> <p>Concussed athletes demonstrated neurometabolic impairment in prefrontal and motor (M1) cortices in the acute phase where NAA:Cr levels remained depressed relative to controls. There was some recovery observed in the chronic phase where Glu:Cr levels returned to those of control athletes; however, there was a pathological increase of m-I:Cr levels in M1 that was only present in the chronic phase.</p> <p>Conclusions</p> <p>These results confirm cortical neurometabolic changes in the acute post-concussion phase as well as recovery and continued metabolic abnormalities in the chronic phase. The results indicate that complex pathophysiological processes differ depending on the post-injury phase and the neurometabolite in question.</p

Bacterial endocarditis due to Listeria monocytogenes in a pregnant diabetic

A case of bacterial endocarditis due to Listeria monocytogenes in a pregnant, Class D diabetic patient is presented. The importance of obtaining proper cultures and instituting appropriate antibiotic therapy promptly is emphasized. A favorable outcome was achieved in spite of the combined risk to the fetus of maternal diabetes and listeria endocarditis

Additive effects of aging and blast induced mild traumatic brain injury within white matter tracts: A novel DTI analysis approach.

Veterans of recent military conflicts have experienced a high rate of mild traumatic brain injuries from exposure to blasts (bTBI). Difficulty detecting the neuroanatomical effects of bTBI using standard imaging protocols, including diffusion tensor imaging (DTI), has hindered the development of evidence-based treatments. A possible reason for this challenge is that many past DTI studies attempting to identify neuroanatomical markers of bTBI have ignored the broad range of cumulative blast exposure among Veterans, and therefore potentially reduced sensitivity to associations between bTBI and DTI metrics. Here, we compare commonly used DTI metrics: fractional anisotropy and mean, axial, and radial diffusivity (FA, MD, AD, RD) in U.S. Military Veterans with and without a history of blast exposure using both the traditional method of dividing participants into two equally weighted groups, and an alternative method, wherein each participant is weighted by their blast exposure quantity, severity, and recency. While no differences in FA, MD, and AD (and minimal in RD) were detected using the traditional method, the alternative method revealed diffuse and extensive changes in all four DTI metrics associated with bTBI. These effects were quantified within 80 anatomically-defined white matter tracts as the percentage of voxels with significant changes, which identified the acoustic and optic radiations, fornix, uncinate fasciculus, inferior occipito-frontal fasciculus, cingulum, and the anterior commissure as the pathways most affected by bTBI. Moreover, additive effects of aging were present in many of the same tracts suggesting that the neuroanatomical effects of bTBI may compound with age