Early Nonischemic Oxidative Metabolic Dysfunction Leads to Chronic Brain Atrophy in Traumatic Brain Injury

Author:

Xu Yueqiao1,McArthur David L2,Alger Jeffry R3,Etchepare Maria2,Hovda David A2,Glenn Thomas C2,Huang Sungcheng4,Dinov Ivo2,Vespa Paul M23

Affiliation:

1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China

2. Department of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA

3. Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA

4. Department of Molecular and Medical Pharmacology, and UCLA-DOE Center for Molecular Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA

Abstract

Chronic brain atrophy after traumatic brain injury (TBI) is a well-known phenomenon, the causes of which are unknown. Early nonischemic reduction in oxidative metabolism is regionally associated with chronic brain atrophy after TBI. A total of 32 patients with moderate-to-severe TBI prospectively underwent positron emission tomography (PET) and volumetric magnetic resonance imaging (MRI) within the first week and at 6 months after injury. Regional lobar assessments comprised oxidative metabolism and glucose metabolism. Acute MRI showed a preponderance of hemorrhagic lesions with few irreversible ischemic lesions. Global and regional chronic brain atrophy occurred in all patients by 6 months, with the temporal and frontal lobes exhibiting the most atrophy compared with the occipital lobe. Global and regional reduction in cerebral metabolic rate of oxygen (CMRO2), cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of glucose were observed. The extent of metabolic dysfunction was correlated with the total hemorrhage burden on initial MRI ( r=0.62, P=0.01). The extent of regional brain atrophy correlated best with CMRO2 and CBF. Lobar values of OEF were not in the ischemic range and did not correlate with chronic brain atrophy. Chronic brain atrophy is regionally specific and associated with regional reductions in oxidative brain metabolism in the absence of irreversible ischemia.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical),Neurology

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