Proton magnetic resonance spectroscopy study of ischemia in intracerebral hemorrhage

Background and purposes. Studies in animals suggest the presence of focal as well as global ischemia in experimental intracerebral hemorrhage, especially when the hematoma reaches the subarachnoid and intraventricular spaces. The confirmation of this findings in humans may have important therapeutical implications as various neuroprotective strategies can be used to minimize the effects of stroke. Methods. The metabolic changes in the perilesional region and in the contralateral hemisphere have been studied in 14 subjects with acute intracerebral hemorrhage by using proton magnetic resonance spectroscopy. A lactate peak and marked decrease of N- acetyl-aspartate have been considered the criteria for the presence of ischemia. Results. A lactate peak in the contralateral hemisphere and a remarkable decrease in N-acetyl- aspartate in the perihemorrhagic area have been observed in one patient with basal ganglia hemorrhage and intraventricular spreading of blood. In four other patients (three in the perihemorrhagic area and one in the contralateral hemisphere) a marked reduction of N-acetyl-aspartate has been found. Conclusions. Though an ischemic spectral pattern can be detected, both in the perilesional area and contralaterally, further studies are needed to make a definitive conclusion about the possibility to detect ischemia in intracerebral hemorrhage with 1 H-MRS.