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Decrease in N-Acetylaspartate Following Concussion May Be Coupled to Decrease in Creatine

Vagnozzi, Roberto MD; Signoretti, Stefano MD, PhD; Floris, Roberto MD; Marziali, Simone MD; Manara, Massimo MD; Amorini, Angela M. PhD; Belli, Antonio MD, PhD; Di Pietro, Valentina PhD; D'Urso, Serafina PhD; Pastore, Francesco S. MD; Lazzarino, Giuseppe PhD; Tavazzi, Barbara PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: July/August 2013 - Volume 28 - Issue 4 - p 284–292
doi: 10.1097/HTR.0b013e3182795045
Concussion in Sports: 2013

Objectives: To assess the time course changes in N-acetylaspartate (NAA) and creatine (Cr) levels in the brain of athletes who suffered a sport-related concussion.

Participants: Eleven nonconsecutive athletes with concussive head injury and 11 sex- and age-matched control volunteers

Main outcome measures: At 3, 15, 30, and 45 days postinjury, athletes were examined by proton magnetic resonance spectroscopy for the determination of NAA, Cr, and choline (Cho) levels. Proton magnetic resonance spectroscopic data recorded for the control group were used for comparison.

Results: Compared with controls (2.18 ± 0.19), athletes showed an increase in the NAA/Cr ratio at 3 (2.71 ± 0.16; P < .01) and 15 (2.54 ± 0.21; P < .01) days postconcussion, followed by a decrease and subsequent normalization at 30 (1.95 ± 0.16, P < .05) and 45 (2.17 ± 0.20; P < .05) days postconcussion. The NAA/Cho ratio decreased at 3, 15, and 30 days postinjury (P < .01 compared with controls), with no differences observed in controls at 45 days postconcussion. Compared with controls, significant increase in the Cho/Cr ratio after 3 (+33%, P < .01) and 15 (+31.5%, P < .01) days postinjury was observed whereas no differences were recorded at 30 and 45 days postinjury.

Conclusions: This cohort of athletes indicates that concussion may cause concomitant decrease in cerebral NAA and Cr levels. This provokes longer time for normalization of metabolism, as well as longer time for resolution of concussion-associated clinical symptoms.

Division of Neurotraumatology and Neuroradiology, Department of Biomedicine and Prevention, University of Rome “Tor Vergata,” Rome, Italy (Drs Vagnozzi, Floris, Marziali, D'Urso, and Pastore); Division of Neurosurgery, Department of Neurosciences—Head and Neck Surgery, “San Camillo” Hospital, Rome, Italy (Dr Signoretti); Association of Sports Physicians Parma, F.M.S.I., Parma, Italy (Dr Manara); Institute of Biochemistry and Clinical Biochemistry, Catholic University of Rome, Rome, Italy (Drs Amorini and Tavazzi); Division of Biochemistry and Molecular Biology, Department of Biology, Geology and Environmental Sciences, University of Catania, Catania, Italy (Dr Lazzarino); and Neuropharmacology and Neurobiology Section, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences and NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham and University Hospitals Birmingham, Birmingham, United Kingdom (Drs Belli and Di Pietro).

Corresponding Author: Giuseppe Lazzarino, PhD, Division of Biochemistry and Molecular Biology, Department of Biology, Geology and Environmental Sciences, Viale A. Doria 6, 95125 Catania, Italy (

This work has been supported in part by research funds of University of Rome “Tor Vergata,” Catholic University of Rome, and University of Catania. The authors thank Mr Salvatore Meo for his technical assistance in preparing the artwork for the manuscript.

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins