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Thalamic proton magnetic resonance spectroscopy in vegetative state induced by traumatic brain injury

¹ Department of Neurosurgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
² Department of Radiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey

Correspondence to:
Correspondence to:
Dr M Uzan, PO Box 5, Cerrahpasa 34301, Istanbul, Turkey;
uzan{at}istanbul.edu.tr

Methods: 14 victims of severe traumatic brain injury who were in the vegetative state and whose magnetic resonance images of the thalamus were normal underwent bilateral thalamic proton (MRS) studies. The N-acetyl aspartate to creatine (NAA:Cr) and choline to creatine (Cho:Cr) ratios were obtained for each patient. The proton thalamic MRS findings of patients who were in a persistent vegetative state (n = 8) and in patients who had regained awareness after being in the vegetative state (n = 6) were compared with proton thalamic MRS findings in five healthy volunteers.

Results: While conventional magnetic resonance imaging suggested that each patient had a normal thalamus, proton MRS indicated that the thalamus of each patient in the series was damaged. The NAA:Cr ratio was significantly lower in the thalami of both the patients who remained in a persistent vegetative state for the duration of the study and in those who regained awareness after being in the vegetative state (p < 0.001). In addition, NAA:Cr ratios were lower in the group of patients who remained in a persistent vegetative state than in the group of patients who regained awareness after being in the vegetative state (p < 0.001).

Conclusions: Results suggest that the NAA:Cr ratio within the thalamus is significant and that thalamic MRS may be helpful when attempting to determine the degree of severity of neuronal and axonal injury in patients in the vegetative state.

Keywords: traumatic brain injury; persistent vegetative state; magnetic resonance spectroscopy; N-acetyl aspartate; thalamus

Abbreviations: Cho, choline; Cr, creatine; MRI, magnetic resonance imaging; MRS, magnetic resonance spectroscopy; NAA, N-acetyl aspartate

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