Reversible Cerebral Metabolism Changes Using Proton Magnetic Resonance Spectroscopy in a Patient with Intracranial Dural Arteriovenous Fistula: A Case Report

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• 作者：Bikei Ryu¹ ; ² ; ^{ryu.bikei@twmu.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takakazu Kawamata² ; Takuma Wakai¹ ; Masahiro Shimizu¹ ; Shinichi Yagi¹ ; Tsuneo Shimizu¹
• 关键词：Cerebral metabolism ; Dural arteriovenous fistula ; N-acetylaspartic acid ; Proton magnetic resonance spectroscopy
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：92
• 期：Complete
• 页码：584.e1-584.e6
• 全文大小：1242 K

文摘

Cerebral metabolism can be disrupted by venous congestion in patients with intracranial dural arteriovenous fistula (DAVF), which may lead to adverse neurological outcomes. However, there are no clear indicators to guide cerebral evaluation and treatment selection in cases of DAVF. We describe a patient with a DAVF whose proton magnetic resonance spectroscopy (¹H-MRS) findings were associated with improvements in clinical status.

Case Description

An elderly woman with a history of myocardial infarction presented with progressive dementia, aphasia, and a severe headache. We detected a transverse-sigmoid sinus DAVF, as well as abnormal levels of lactate and N-acetylaspartic acid (NAA) in the ¹H-MRS, and successfully treated the patient using surgical sinus skeletonization. However, follow-up ¹H-MRS revealed inconsistent reversals in the levels of lactate and NAA. In addition, we calculated the NAA/creatinine ratios from before and after surgery, which revealed postoperative increases in the ratios for the left temporal, right parietal, and left parietal regions. These increases occurred concurrently with improvements in the patient's cognitive function.

Conclusions

¹H-MRS may be useful for pretreatment detection of increased lactate levels, decreased NAA levels, and/or decreased NAA/creatinine ratios. These findings may indicate poorer cerebral metabolism, and show a need for more aggressive treatment. Furthermore, ¹H-MRS may be useful for evaluating the effect of conservative treatment and for indicating conversion to a more aggressive treatment.