PREDICTION OF ISCHEMIC STROKE REHABILITATION OUTCOME USING INITIAL ADMISSION PROTON MAGNETIC RESONANCE SPECTROSCOPY

Abstract

Background: To predict stroke outcome in advance is important for patients, family supporters,
and the community. Imaging has created a means to explore the stroke process in vivo,
particularly its underlying pathophysiology and recovery mechanisms. Objective: this work was
done for prediction of ischemic stroke rehabilitation outcome using1H-MRS findings with clinical
measures of admission. Methods: The study included 55 patients with a recent ischemic stroke
(mean age, 69±12 years). FIM scores, National Institute of Health Stroke Scale (NIHSS) and 1HMRS
were used for assessment which was done on admission (1st) and after 6 months of
rehabilitation (2nd). Results: At 1st assessment; N-acetylaspartate from infarcted area/
contralateral area(iNAA/cNAA), choline and creatine-phosphocreatine from infarcted area/
contralateral area (iCho/cCho and iCr/ cCr respectively) were significantly reduced in all
infarcted areas. Lactate was detected in 49/55 patients. Comparing 2nd assessment versus 1st;
There were significant increment of iNAA/cNAA, iCr/cCr and iCho/cCho and significant
decrement in lactate detection 9/55. Regarding 1st assessment; a significant relation was detected
between decreased iNAA/cNAAratio , lactate detection and decrement of the FIM scores at 2nd
assessment. 1st assessment decreased levels of( iNAA/cNAA),( iCho/cCho) and( iCr/ cCr) had
significantly positive correlated with the FIM total scores at 1st assessments. Only (
iNAA/cNAA) decreased levels had significant positive correlated with the FIM total scores of
2nd assessments. 1st assessment lactate detection and NHISS high scores had a significant
negative correlation with the FIM scores of 1st only. Multiple linear regression analysis was
performed. The FIM total score at discharge was significantly influenced by the1st assessment
NAAi/NAAc, lactate detection and NIHSS score. Conclusion:1H-MRS at acute phase may
provide prognostic information to the outcome after rehabilitation.