In experimental hydrocephalus complex metabolic changes occur. Unfortunately, assessment of metabolic changes has been largely limited to ex vivo studies. This study therefore aimed at examining early metabolic changes in vivo in rats with kaolin-hydrocephalus (n = 15; sham-operated controls, n = 15) using in vivo 13C and 1H magnetic resonance spectroscopy (MRS). In addition, metabolism was assessed by in vivo magnetic resonance imaging (MRI), as well as ex vivo 13C MRS and high pressure liquid chromatography (HPLC). As revealed by in vivo 13C MRS, rats with acute kaolin-hydrocephalus are able to maintain normal TCA cycle activity. However, subtle metabolic changes in neuronal metabolism are reflected by decreased glutamine, glutamate and NAA levels assessed by in vivo 1H MRS. Also, astrocytic metabolism seems impaired as evidenced by decreased 13C labelling of C2 glutamine. We hypothesize that early biochemical disturbances might be the first step that leads to delayed neuronal damage and apoptosis in kaolin-hydrocephalus. In the future non-invasive techniques such as in vivo MRS might help to assist in therapeutic decision making and the timing of surgical intervention.
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