Annals of Rehabilitation Medicine

Neuroprotective Effect of Ischemic Preconditioning in Traumatic Brain Injured Rats.: Yang, Hee Seung , Chun, Min Ho , Park, Ji Young , Kim, Bo Ryun , Kim, Sang Tae , Cho, Hee Jin; J Korean Acad Rehabil Med 2010;34(6):656-662.

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ObjectiveTo test the hypothesis that a transient non-lethal ischemia (ie. ischemic preconditioning(IPC)) would protect against subsequent traumatic brain injury (TBI) using ¹H-magnetic resonance spectroscopy (MRS).

MethodSprague-Dawley rats were randomized to sham ischemia procedures followed by TBI, IPC followed by TBI, and IPC followed by sham TBI. IPC was induced by 20 min of right common carotid artery occlusion 24 hour prior to TBI, and experimental injury was induced using lateral fluid percussion model of moderate severity. We measured metabolic changes with ¹H-MRS and conducted motor function and 4 arm maze tests to identify neurobehavioral deficits and cognitive deficits, respectively, at 1 day to 4 weeks post-injury.

ResultsThe NAA/Cr ratios in the affected hemisphere were significantly lower in TBI than in IPC-TBI group at 2 (p=0.006) and 4 (p=0.012) weeks and in the unaffected hemisphere at 4 weeks (p=0.030). TBI group also showed a trend towards reduction in NAA/Cho ratio in the affected hemisphere at 4 weeks (p=0.054).

ConclusionBrief IPC 24 hours before moderate lateral fluid percussion brain injury increases the resistance to brain damage and that is associated with changes in brain metabolites. These findings indicate that IPC induces neuroprotection against TBI in rat brains.

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Human Mesenchymal Stem Cells Derived from Bone Marrow in Traumatic Brain Injury of Rat Migrate to the Site of Injury.: Kang, Si Hyun , Chun, Min Ho , Kim, Sang Tae , Cho, Hee Jin; J Korean Acad Rehabil Med 2009;33(5):520-526.

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Objective
To define the migration and differentiation of adult human mesenchymal stem cells (hMSCs) derived from bone marrow, and their effect on neurobehavioral and cognitive improvements, after traumatic brain injury (TBI) in rats. Method: Two days after TBI, 1×106 hMSCs were injected into the corpus callosum of fifteen rats, on the contralateral side of TBI. Eleven rats received sham-operation as a control group. Neurobehavioral and Barnes maze tests, and magnetic resonance spectroscopy (MRS) were performed on days 1 and 28 after TBI. Immunohistochemical staining was performed to evaluate distribution and differentiation of hMSCs on day 56. Results: After 28 days, scores on the neurobehavioral test, Barnes maze test, and magnetic resonance spectroscopy (MRS) were higher than on day 1 in both the stem-cell and control groups, but there were no between-group differences. On day 56, injected hMSCs stained positively with MAB- 1281 were distributed in ipsilateral corpus callosum, lesion boundary zone, parietal cortex, and thalamic area around the lateral ventricle. Conclusion: hMSCs injected to the contralateral side of TBI survive and migrate to various areas of the ipsilateral hemisphere. We observed no neurobehavioral or cognitive improvements in test animals, indicating the need to adjust experimental methodologies including the development of appropriate tests to evaluate neurobehavioral and cognitive functions of rats. (J Korean Acad Rehab Med 2009; 33: 520-526)

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Clinical and Laboratory Features of Children with Mitochondrial Respiratory Chain Enzyme Complexes Defect and Neurological Abnormalities: A case report.: Ahn, Seung Joon , Park, Eun Sook , Lee, Young Mock , Kim, Se Hoon , Kim, Dong Jin , Rha, Dong Wook; J Korean Acad Rehabil Med 2009;33(1):118-122.

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Mitochondrial cytopathies represent a heterogeneous group of multisystem disorder that preferentially affects the muscle and nervous systems. Mitochondrial respiratory chain enzyme complexes (MRC) defect can be the cause of many unexplained neurological disorders including epilepsy, cerebral palsy, delayed development and hypotonia. We retrospectively reviewed clinical and laboratory features of 16 patients who showed defects in MRC activity, confirmed by biochemical assay from spectrophotometry in muscles to characterize clinical and laboratory features for MRC defects and provide more precise diagnosis and effective treatments. In the patients with uncontrolled seizure activity, developmental regression, characteristic features of bilateral symmetric high signal intensity at deep nucleus and/or white matter in T2WI, the mitochondrial cytopathies should be added to the list of differential diagnoses. And lactate elevation in magnetic resonance spectroscopy (MRS) can be useful in the diagnosis of mitochondrial cytopathies. (J Korean Acad Rehab Med 2009; 33: 118-122)

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Usefulness of 1H Magnetic Resonance Spectroscopy for Evaluation of Cognitive Impairment after Subarachnoid Hemorrhage Caused by Rupture of Middle Cerebral Artery Aneurysm.: Kang, Si Hyun , Chun, Min Ho , Na, Hyo Jin , Kim, Sang Tae; J Korean Acad Rehabil Med 2007;31(5):516-520.

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Objective
To investigate the relationship between cognitive impairment and 1H magnetic resonance spectroscopy (1H MR spectroscopy) in patients with subarachnoid hemorrhage (SAH) caused by rupture of middle cerebral artery (MCA) aneurysm. Method: 1H MR spectroscopy was performed in 6 patients with SAH after rupture of MCA aneurysm and in 20 controls. Image-guided localized 1H MR spectra were obtained from left parietal white matter (PWM). The cognitive status was evaluated using the Mini Mental Status Examination (MMSE), and the scores were correlated with N- acetyl aspartate/creatine (NAA/Cr), choline/creatine (Cho/ Cr), and myoinositol/creatine (mI/Cr) metabolic ratios. Results: NAA/Cr was significantly lower, and Cho/Cr was higher in SAH patients than in controls in the left PWM (p＜0.05). NAA/Cr in the left PWM was correlated with MMSE (p＜0.05), but Cho/Cr and mI/Cr in the left PWM was not correlated with MMSE (p＞0.05). Conclusion: 1H MR spectroscopy could be helpful in the evaluation of cognitive impairment in SAH. (J Korean Acad Rehab Med 2007; 31: 516-520)

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The Findings of 1H Magnetic Resonance Spectroscopy in Children with Mental Retardation or Autism.: Lee, Jung Hwan , Sung, In Young , Kim, Ki Soo , Kim, Sang Tae , Lee, Jung Hee; J Korean Acad Rehabil Med 2006;30(4):322-327.

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Objective
To investigate the findings of patients with autism or mental retardation shown in ¹H magnetic resonance spectroscopy (¹H MRS) and the correlation between findings in ¹H MRS and degree of language developmental delay. Method: ¹H MRS was performed in thirty five patients with autism or mental retardation. [N-Acetylaspartate (NAA)/ Creatine (Cr)], [Choline (Cho)/Cr], and [Myoinositol (mI)/ Cr] were measured and compared with those of control group. Also the correlation between ¹H MRS findings and the degree of language developmental delay was investigated. Results: Increased [Cho/Cr] was shown in parietal white matter and frontal gray matter in patients with autism and mental retardation. No significant differences were revealed in any metabolite ratio between mental retardation and autism. There were no significant correlations between the degree of language developmental delay and metabolite ratios. Conclusion: Myelin degeneration in parietal white matter and fronal gray matter could be related to autism and mental retardation. (J Korean Acad Rehab Med 2006; 30: 322- 327)

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H MR Spectroscopy on Parkinson's-like Syndrome Induced by Manganese Intoxication: A Case Report.: Kim, Chang Hwan , Kim, Myeong Ok , Jung, Han Young , Roh, Gill Ho , Lim, Myung Kwan; J Korean Acad Rehabil Med 2001;25(3):514-518.

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Manganese intoxificaton is a well-known cause of Parkinson's like syndrome.

We describe a 46-year-old man who had been occupationally exposed to manganese and report the case with hydrogen magnetic resonance spectroscopy (¹H MRS). Ratios of N-acetyl-aspartate (NAA) to creatine were significantly reduced in basal ganglia regions compared to normal subjects. The level of NAA was decreased in basal ganglia regions may indicate neuronal dysfunction. ¹H MRS can provide detailed information of brain damage, therefore the ¹H MRS is very useful in diagnosis of manganese intoxification.

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Usefulness of ¹H MR Spectroscopy for Detection of Diffuse Axonal Injury in the Traumatic Brain Injured Patients: Yoon, Se Jin , Kim, Sang Tae , Lee, Jung Hee , Chun, Min Ho; J Korean Acad Rehabil Med 2000;24(5):842-849.

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Objective: The purpose of this study was to determine whether ¹H magnetic resonance spectroscopy (MRS) is a potential tool for the detection of microscopic diffuse axonal injury (DAI) and for the evaluation of functional status of patients with traumatic brain injury (TBI).

Method: Seven patients with severe TBI and fourteen normal control volunteers were examined. Image guided spectra of localized in vivo ¹H MRS were obtained from parietal white matter (PWM) and occipital gray matter (OGM) in which definite abnormality was not detected in MR imaging. The severity of TBI was evaluated by the initial Glasgow Coma Scale (GCS), and the functional status was evaluated by Functional Independence Measure (FIM) at the time of the MRS examination, approximately 2 months after onset.

Results: In PWM, the [N-acetylaspartate(NAA)/Creatine(Cr)] ratio was significantly lower, and the [Choline(Cho)/Cr] and [myo-Inositol(mI)/Cr] ratios were significantly higher in the patients with TBI than those of normal volunteers. There was no significant correlation between the ratios of metabolites and GCS scores. However, interestingly, a significant correlation between the [NAA/Cr] ratio in PWM and the FIM scores was observed.

Conclusion: We could conclude that decreased [NAA/Cr], increased [Cho/Cr], and increased [mI/Cr] ratios in PWM can be considered as markers for DAI. Localized ¹H MRS has a potential to be used for the detection of DAI in vivo and evaluation of functional status of the patients with TBI.