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  • Print publication year: 2009
  • Online publication date: August 2010

6 - MRS in stroke and hypoxic–ischemic encephalopathy


Key points

MRS is highly sensitive to metabolic changes associated with hypoxic or ischemic injury to the brain.

Lactate is elevated during acute hypoxia or ischemia, and may also increase during “secondary” energy failure after reperfusion.

NAA decreases with prolonged hypoxia or ischemia.

In 31P MRS, high-energy phosphates decrease, inorganic phosphate increases, and pH decreases during acute hypoxia and ischemia.

Both 1H and 31P MRS offer prognostic information in HIE, which may be complementary to, and sometimes easier to interpret than, conventional or diffusion-weighted MRI in the neonatal brain.

DWI may be better for evaluating small HIE lesions than MRS.

Introduction: MR spectroscopy in stroke

A stroke is the rapidly developing loss of brain function due to vascular failure to supply adequate blood nutrients to the brain. Stroke can be due to ischemia (lack of blood supply) caused by thrombosis or embolism, or due to a hemorrhage (vasculature rupture). Acute stroke is a medical emergency, and imaging plays an important role in confirming the clinical diagnosis of stroke, categorizing it as either ischemic or hemorrhagic, and identifying the underlying pathophysiology. Increasingly, imaging is also being used to guide therapeutic interventions and monitor their success. Traditionally, X-ray computed tomography has been the imaging modality of choice, primarily because of its speed and widespread availability.

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