Decrease in N-acetylaspartate following concussion may be coupled to decrease in creatine

J Head Trauma Rehabil. Jul-Aug 2013;28(4):284-92. doi: 10.1097/HTR.0b013e3182795045.

Abstract

Objectives: To assess the time course changes in N-acetylaspartate (NAA) and creatine (Cr) levels in the brain of athletes who suffered a sport-related concussion.

Participants: Eleven nonconsecutive athletes with concussive head injury and 11 sex- and age-matched control volunteers

Main outcome measures: : At 3, 15, 30, and 45 days postinjury, athletes were examined by proton magnetic resonance spectroscopy for the determination of NAA, Cr, and choline (Cho) levels. Proton magnetic resonance spectroscopic data recorded for the control group were used for comparison.

Results: Compared with controls (2.18 ± 0.19), athletes showed an increase in the NAA/Cr ratio at 3 (2.71 ± 0.16; P < .01) and 15 (2.54 ± 0.21; P < .01) days postconcussion, followed by a decrease and subsequent normalization at 30 (1.95 ± 0.16, P < .05) and 45 (2.17 ± 0.20; P < .05) days postconcussion. The NAA/Cho ratio decreased at 3, 15, and 30 days postinjury (P < .01 compared with controls), with no differences observed in controls at 45 days postconcussion. Compared with controls, significant increase in the Cho/Cr ratio after 3 (+33%, P < .01) and 15 (+31.5%, P < .01) days postinjury was observed whereas no differences were recorded at 30 and 45 days postinjury.

Conclusions: This cohort of athletes indicates that concussion may cause concomitant decrease in cerebral NAA and Cr levels. This provokes longer time for normalization of metabolism, as well as longer time for resolution of concussion-associated clinical symptoms.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aspartic Acid / analogs & derivatives*
  • Aspartic Acid / analysis
  • Aspartic Acid / metabolism
  • Athletic Injuries / diagnosis
  • Athletic Injuries / metabolism
  • Biomarkers / analysis
  • Biomarkers / metabolism
  • Brain Concussion / diagnosis*
  • Brain Concussion / metabolism*
  • Case-Control Studies
  • Choline / analysis
  • Choline / metabolism*
  • Cohort Studies
  • Creatine / analysis
  • Creatine / metabolism*
  • Female
  • Follow-Up Studies
  • Glasgow Coma Scale
  • Humans
  • Injury Severity Score
  • Magnetic Resonance Spectroscopy / methods
  • Male
  • Recovery of Function / physiology
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Sports
  • Time Factors
  • Young Adult

Substances

  • Biomarkers
  • Aspartic Acid
  • N-acetylaspartate
  • Creatine
  • Choline