Neurocritical Care

, Volume 19, Issue 2, pp 183–191

Impact of Methamphetamine on Regional Metabolism and Cerebral Blood Flow After Traumatic Brain Injury

  • Kristine O’Phelan
  • Thomas Ernst
  • Dalnam Park
  • Andrew Stenger
  • Katherine Denny
  • Deborah Green
  • Cherylee Chang
  • Linda Chang
Original Article

DOI: 10.1007/s12028-013-9871-9

Cite this article as:
O’Phelan, K., Ernst, T., Park, D. et al. Neurocrit Care (2013) 19: 183. doi:10.1007/s12028-013-9871-9

Abstract

Background

Substance abuse is a frequent comorbid condition among patients with traumatic brain injury (TBI), but little is known about its potential additive or interactive effects on tissue injury or recovery from TBI. This study aims to evaluate changes in regional metabolism and cerebral perfusion in subjects who used methamphetamine (METH) prior to sustaining a TBI. We hypothesized that METH use would decrease pericontusional cerebral perfusion and markers of neuronal metabolism, in TBI patients compared to those without METH use.

Methods

This is a single center prospective observational study. Adults with moderate and severe TBI were included. MRI scanning was performed on a 3 Tesla scanner. MP-RAGE and FLAIR sequences as well as Metabolite spectra of NAA and lactate in pericontusional and contralateral voxels identified on the MP-RAGE scans. A spiral-based FAIR sequence was used for the acquisition of cerebral blood flow (CBF) maps. Regional CBF images were analyzed using ImageJ open source software. Pericontusional and contralateral CBF, NAA, and lactate were assessed in the entire cohort and in the METH and non-METH groups.

Results

Seventeen subjects completed the MR studies. Analysis of entire cohort: pericontusional NAA concentrations (5.81 ± 2.0 mM/kg) were 12 % lower compared to the contralateral NAA (6.98 ± 1.2 mM/kg; p = 0.03). Lactate concentrations and CBF were not significantly different between the two regions; however, regional CBF was equally reduced in the two regions. Subgroup analysis: 41 % of subjects tested positive for METH. The mean age, Glasgow Coma Scale, and time to scan did not differ between groups. The two subject groups also had similar regional NAA and lactate. Pericontusional CBF was 60 % lower in the METH users than the non-users, p = 0.04; contralateral CBF did not differ between the groups.

Conclusion

This small study demonstrates that tissue metabolism is regionally heterogeneous after TBI and pericontusional perfusion was significantly reduced in the METH subgroup.

Keywords

Adult brain injuryMRIBlood flowMetabolismAlcohol and drug abuse

Supplementary material

12028_2013_9871_MOESM1_ESM.pdf (662 kb)
Supplementary material 1 (PDF 662 kb)

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kristine O’Phelan
    • 1
  • Thomas Ernst
    • 2
  • Dalnam Park
    • 3
  • Andrew Stenger
    • 2
  • Katherine Denny
    • 4
  • Deborah Green
    • 5
  • Cherylee Chang
    • 2
    • 6
  • Linda Chang
    • 2
  1. 1.Department of NeurologyMiller School of Medicine, University of MiamiMiamiUSA
  2. 2.Neuroscience and MR Research Program, Department of Medicine, John A Burns School of MedicineUniversity of Hawaii at ManoaHonoluluUSA
  3. 3.School of MedicineOregon Health and Science UniversityPortlandUSA
  4. 4.Miller School of MedicineUniversity of MiamiMiamiUSA
  5. 5.Department of NeurologyBoston Medical Center, Boston University School of MedicineBostonUSA
  6. 6.Neuroscience InstituteThe Queens Medical CenterHonoluluUSA