In vivo evidence for axonal dysfunction remote from focal cerebral demyelination of the type seen in multiple sclerosis
In vivo evidence for axonal dysfunction remote from focal cerebral demyelination of the type seen in multiple sclerosis
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DOI：
10.1093/brain/122.10.1933
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发表时间：
1999-10-01
期刊：
影响因子：
14.5
通讯作者：
Arnold, DL
中科院分区：
文献类型：
--
作者：
De Stefano, N;Narayanan, S;Arnold, DL
为了检测远离急性脱髓鞘病变的白色物质束的轴突损伤或功能障碍，我们使用脑质子磁共振光谱成像来测量N-乙酰天冬氨酸（NAA）的变化，这是一种神经元完整性的指标，在3名患有多发性硬化早期发现的大型孤立性脑脱髓鞘病变的患者的正常半球的白色物质中。在急性期的疾病，所有患者表现出正常的比率NAA肌酸（Cr）共振强度在整个半球对侧的病变。1个月后复查时，所有患者对侧大脑半球与脱髓鞘病变对应的体素均显示异常低的NAA/Cr共振强度比（NAA/Cr降低22-35%），其余正常半球的体素均显示正常的NAA相对共振强度。所有患者在6个月后，正常半球体素中NAA/Cr的降低均得到解决，其时间过程与病变内体素中NAA的观察结果相似。我们的结论是，损伤或功能障碍的影响，轴突穿越炎症病变，可以在长距离传输的正常出现的白色的问题。这种远程的继发性效应可能是投射通路中轴突功能障碍的表现，或者是从急性损伤中恢复的大脑中看到的功能通路的重组。
To test for axonal damage or dysfunction in white matter tracts remote from acute demyelinating lesions, we used brain proton magnetic resonance spectroscopic imaging to measure changes in N-acetyl aspartate (NAA), an index of neuronal integrity, in the white matter of the normal-appearing hemisphere of three patients with large, solitary brain demyelinating lesions of the type seen early in multiple sclerosis. During the acute phase of their disease, all patients showed normal ratios of NAA to creatine (Cr) resonance intensity throughout the hemisphere contralateral to the lesion. However, on examination 1 month later, all of the patients showed abnormally low NAA/Cr resonance intensity ratios (reduction of NAA/Cr by 22-35%) in voxels of the contralateral hemisphere which were homologous to the demyelinating lesion, Other voxels in the normal-appearing hemisphere showed normal NAA relative resonance intensities. The decrease in NAA/Cr in voxels of the normal-appearing hemispheres resolved in all patients after 6 months, with a time course similar to that observed for NAA from voxels within the lesions. We conclude that effects of damage or dysfunction to axons traversing inflammatory lesions can be transmitted over long distances in the normal-appearing white matter. Such remote, secondary effects may be an expression of dysfunction of axons in projection pathways or of the reorganization of functional pathways seen in brains recovering from an acute injury.