The association between cognitive status and abnormal findings on MR spectroscopy in the patients with hypoxic brain damage.

초록

Background & Objective : Hypoxic brain damage is one of main causes leading to permanent brain damage and severe cognitive impairment. However, it remain unclear whether brain image could predict the longterm cognitive status. We investigated the association between longterm cognitive outcomes and abnormal findings on MR spectroscopyin acute period. Methods : We selected the patients with acute hypoxic brain damage, who were admitted from 2005 to 2014. They took the MR scans between 7 and fourteen days after hypoxic event. Left frontal, occipital, temporal and basal ganglia were chosen for the evaluation of MR spectroscopy. The patients with the history of stroke or aged less than 20 years, were excluded. All patients also took the minimental status examination(MMSE) and Glascow Coma Scales on 7 days and one month after hypoxic insult. The patients with good cognitive outcomes were defined as one having 18 or more points on MMSE at one month of onset. Result : A total of nine patients were included in this study (51.7±11.0 years). The median point of MMSE was 18. Five patients had good cognitive outcomes. Compared to the subject with poor outcomes, those with good outcomes had the higher NAA/Creatine peak ratio on frontal and temporal area, higher GCS and MMSE on seven days of hypoxic insult and less frequency of ventilator care. Hypothermia was tried to only two patients and they seemed higher NAA/Creatine peak ratio in the frontal cortex than the others. Conclusions : MR spectroscopy has several limitations. Most of all, the MR spectroscopy was only available in the patients with stable vital sign. However, MR spectroscopy could be helpful for the prediction of good cognitive status in chronic period in the patients with acute hypoxic insult.