1673 IN VIVO VARIATION OF BRAIN OXIDATIVE metabolism with therapeutic lumbar PUNCTURE (LP)

Abstract

Sequential cerebral spectra of phosphorus-containing compounds, ATP, phosphocreatine (Pcr), inorganic phosphate (Pi), phosphodiester (PD), and phosphomonoester (PME), by 31-P nuclear magnetic resonance (NMR) were obtained in a severely asphyxiated premature infant with hydrocephalus and seizures. Between days 2-20, 10 therapeutic LP's were done and NMR cerebral spectra were obtained pre (a) and post (p) LP. Pcr/Pi (normal x = 1.01), a measure of bioenergetic reserve, was low at 48h; Left (L) = 0.50, Right (R) = 0.60. After the initial LP, Pcr/Pi rose to L=1.4 and R=0.6. After subsequent LP's, a sharp decrease in Pcr/Pi was followed by a rebound (a LP, L=1.50, R=1.03; p LP, L=0.87, R=0.62; 1½ hrs p LP, L=1.52, R=1.66). Pcr/Pi increased by day 8 (L=1.52, R=1.60) then stabilized during the next month (L=1.0, R=0.8). Tissue pH did not change significantly (day 5: a LP=7.07, p LP=7.02, 1½ hrs p LP=7.08; day 8: a LP=7.12, p LP=7.02, 1½ hrs p LP=1.12). PME/β-ATP, a precursor in membrane biosynthesis, declined (day 2, L=3.15, R=2.53; day 46, L=1.46, R=1.17) but changed inconsistently post LP. Acute changes in Pcr/Pi and PME/β-ATP represent changes in local cerebral metabolism. Removal of 5 cc of CSF may result in acute intracerebral tissue shifts, acute hydrostatic changes with probable effects on CSF and cerebral blood flow, and hence provision of metabolic substrate to brain tissue. These data suggest that acute transient changes in Pcr/Pi and PME/β-ATP, representing changes in local cerebral metabolism, reflect general changes in cerebral metabolic or seizure activity.

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