Proton Spectroscopy in Patients With Post-Traumatic Headache Attributed to Mild Head Injury

Authors

  • Elder Sarmento MD, Sci,

    1. From the Federal Fluminense University – Neurology, Rio de Janeiro, Brazil (E. Sarmento, P. Moreira, C. Brito, J. Souza, and C. Jevoux); UniFOA – Neurology, Rio de Janeiro, Brazil (E. Sarmento and C. Brito); Merck Research Laboratories – Global Director for Scientific Affairs – Neuroscience, Whitehouse Station, NJ, USA, Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal).
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  • Pedro Moreira MD, PhD,

    1. From the Federal Fluminense University – Neurology, Rio de Janeiro, Brazil (E. Sarmento, P. Moreira, C. Brito, J. Souza, and C. Jevoux); UniFOA – Neurology, Rio de Janeiro, Brazil (E. Sarmento and C. Brito); Merck Research Laboratories – Global Director for Scientific Affairs – Neuroscience, Whitehouse Station, NJ, USA, Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal).
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  • Claudio Brito MD, Sci,

    1. From the Federal Fluminense University – Neurology, Rio de Janeiro, Brazil (E. Sarmento, P. Moreira, C. Brito, J. Souza, and C. Jevoux); UniFOA – Neurology, Rio de Janeiro, Brazil (E. Sarmento and C. Brito); Merck Research Laboratories – Global Director for Scientific Affairs – Neuroscience, Whitehouse Station, NJ, USA, Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal).
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  • Jano Souza MD, PhD,

    1. From the Federal Fluminense University – Neurology, Rio de Janeiro, Brazil (E. Sarmento, P. Moreira, C. Brito, J. Souza, and C. Jevoux); UniFOA – Neurology, Rio de Janeiro, Brazil (E. Sarmento and C. Brito); Merck Research Laboratories – Global Director for Scientific Affairs – Neuroscience, Whitehouse Station, NJ, USA, Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal).
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  • Carla Jevoux MD, Sci,

    1. From the Federal Fluminense University – Neurology, Rio de Janeiro, Brazil (E. Sarmento, P. Moreira, C. Brito, J. Souza, and C. Jevoux); UniFOA – Neurology, Rio de Janeiro, Brazil (E. Sarmento and C. Brito); Merck Research Laboratories – Global Director for Scientific Affairs – Neuroscience, Whitehouse Station, NJ, USA, Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal).
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  • Marcelo Bigal MD, PhD

    1. From the Federal Fluminense University – Neurology, Rio de Janeiro, Brazil (E. Sarmento, P. Moreira, C. Brito, J. Souza, and C. Jevoux); UniFOA – Neurology, Rio de Janeiro, Brazil (E. Sarmento and C. Brito); Merck Research Laboratories – Global Director for Scientific Affairs – Neuroscience, Whitehouse Station, NJ, USA, Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal).
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  • Conflict of Interest: Dr. Bigal is an employee of Merck Research Laboratories. All other authors report no conflicts of interest.

Elder M. Sarmento, Santos Dumont street, 156, Centro, Barra Mansa, Rio de Janeiro, Brazil 27310-150.

Abstract

Background.— Post traumatic headaches (PTH) following mild head injury (MHI) impose important diagnostic challenges to clinicians, and are often the scope of litigation.

Objective.— To investigate whether spectroscopy magnetic resonance imaging (MRS) demonstrates markers of PTH following MHI.

Methods.— We imaged individuals with PTH following MHI (n = 17), as well as controls (n = 12), using Proton MRS (1-HS MRI). We estimated the metabolic ratios of N-acetylaspartate (NAA) and choline (Cho), relative to creatine (Cr). Compared with controls, individuals with PTH following MHI had reduced values of NAA in the right (1.64 ppm vs 2.05 ppm, P = .012) and left anterior regions of the frontal lobe white matter (1.52 ppm vs 2.10 ppm; P = .024); anterior (1.52 ppm vs 1.78 ppm; P = .0155) and posterior medial region of the frontal lobes (1.6 ppm vs 2.07 ppm; P = .0045), and medial region of parietal lobes (1.76 ppm vs 2.23 ppm; P = .0065). Contrasted to controls, Cho measures were statistically increased in the posterior region of the white matter of the right side fontal lobe (1.18 ppm vs 0.99 ppm; P = .0095), anterior medial region of the frontal lobe (1.20 ppm; vs 1.07 ppm; P = .0265), and medial region of the parietal lobes (0.92 ppm vs 0.65 ppm; P = .0005).

Conclusions.— Proton MRS may be useful as an imaging marker for PTH following mild injury. Future studies should contrast PTH following mild vs severe trauma, as well as PTH with other forms of headache, to clarify if the findings are specific of the disease, may be correlated with disease severity, or if they are unspecific headache markers.

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