Assessment of mitochondrial impairment and cerebral blood flow in severe brain injured patients

Gunes A. Aygok, Anthony Marmarou, Panos P. Fatouros, Birgit Kettenmann, Ross M. Bullock

Research output: Chapter in Book/Report/Conference proceedingChapter

11 Scopus citations


Background We believe that in traumatic brain injury (TBI), the reduction of N-acetyl aspartate (NAA) occurs in the presence of adequate cerebral blood flow (CBF) which would lend support to the concept of mitochondrial impairment. The objective of this study was to test this hypothesis in severely injured patients (GCS 8 or less) by obtaining simultaneous measures of CBF and NAA. Methods Fourteen patients were studied of which six patients presented as diffuse injury at admission CT, while focal lesions were present in eight patients. CBF using stable xenon method was measured at the same time that NAA was measured by magnetic resonance proton spec-troscopy (1HMRS) in the MR suite. Additionally, diffusion weighted imaging (DWI) and maps of the apparent diffusion coefficient (ADC) were assessed. Findings In diffuse injury, NAA/Cr reduction occurred uniformly throughout the brain where the values of CBF in all patients were well above ischemic threshold. In focal injury, we observed ischemic CBF values in the core of the lesions. However, in areas other than the core, CBF was above ischemic levels and NAA/Cr levels were decreased. Conclusions Considering the direct link between energy metabolism and NAA synthesis in the mitochondria, this study showed that in the absence of an ischemic insult, reductions in NAA concentration reflects mitochondrial dysfunction.

Original languageEnglish (US)
Title of host publicationIntracranial Pressure and Brain Monitoring XIII
Subtitle of host publicationMechanisms and Treatment
PublisherSpringer-Verlag Wien
Number of pages5
ISBN (Print)9783211855775
StatePublished - 2008

Publication series

NameActa Neurochirurgica, Supplementum
ISSN (Print)0065-1419


  • Apparent diffusion coefficient (ADC)
  • Cerebral blood flow (CBF)
  • Mitochondrial impairment
  • N-acetyl aspartate (NAA)

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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