Decrease in n-acetylaspartate following concussion may be coupled to decrease in creatine

Objectives: To assess the time course changes in brain N-acetylaspartate (NAA) and creatine (Cr) in athletes who suffered a sport-related concussion. Participants: Eleven non-consecutive concussed athletes and 11 sex and age-matched control volunteers. Main outcome measures: At 3, 15, 30 and 45 days post-injury, athletes were examined by proton Magnetic Resonance Spectroscopy (1H-MRS) for the determination of NAA,(Cr) and choline (Cho). 1H-MRS data recorded in the control group were used for comparison. Results: Compared to controls (2.18 ± 0.19), athletes showed an NAA/Cr increase at 3 (2.71 ± 0.16; p < 0.01) and 15 days (2.54 ± 0.21; p < 0.01), followed by a decrease and subsequent normalization at 30 (1.95 ± 0.16, p < 0.05) and 45 days(2.17 ± 0.20; p <0.05) post-concussion. NAA/Cho decreased at 3, 15 and 30 days post-injury (p < 0.01 compared to controls), with no differences from controls at 45 days post-concussion. Significant increase in the Cho/Cr after 3 (+33%, p < 0.01) and 15 (+31.5%, p < 0.01) days post-injury was observed, whilst no differences compared to controls were recorded at 30 and 45 days post-impact. Conclusions: This cohort of athletes indicates that concussion may cause concomitant decrease in cerebral NAA and Cr. This occurrence provokes longer time of metabolism normalization, as well as longer resolution time of concussion-associated clinical symptoms.