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Brain Abnormalities in Gulf War Syndrome: Evaluation with ¹H MR Spectroscopy¹

¹ From the Depts of Internal Medicine, Section of Epidemiology (R.W.H., W.W.M.), Radiology (G.G.M., M.A.D., J.L.F.), and Psychiatry (F.P.), University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8874, and Dallas Veterans Affairs Medical Center, Tex (F.P.). From the 1999 RSNA scientific assembly. Received Nov 8, 1999; revision requested Jan 7, 2000; revision received Jan 28; accepted Mar 13. Supported by the U.S. Army Medical Research and Materiel Command under cooperative agreement no. DAMD17-97-2-7025; by U.S. Public Health Service grant M01-RR00633; by a grant from the Perot Foundation; and by a grant from Philips Medical Systems of North America. Address correspondence to R.W.H.

PURPOSE: To test for neuronal brain damage in the basal ganglia and brainstem in Gulf War veterans by using magnetic resonance (MR) spectroscopy.

MATERIALS AND METHODS: Twenty-two Gulf War veterans with one of three factor analysis–derived syndromes (case patients); 18 well veterans matched for age, sex, and education level (control subjects); and six Gulf War veterans with syndrome 2 from a different population (replication sample) underwent long echo time (272 msec) proton (hydrogen 1) MR spectroscopy on a 4 x 2 x 2-cm voxel in the basal ganglia bilaterally and a 2 x 2 x 2-cm voxel in the pons. Syndromes 1–3 are described as "impaired cognition," "confusion-ataxia," and "central pain," respectively.

RESULTS: The N-acetylaspartate–to-creatine (NAA/Cr) ratio, which reflects functional neuronal mass, was significantly lower in the basal ganglia and brainstem of Gulf War veterans with the three syndromes than in those structures of the control subjects (P = .007). The finding was corroborated in the replication sample (P = .002). Veterans with syndrome 2 (the most severe clinically) had evidence of decreased NAA/Cr in both the basal ganglia and the brainstem; those with syndrome 1, in the basal ganglia only; and those with syndrome 3, in the brainstem only.

CONCLUSION: Veterans with different Gulf War syndromes have biochemical evidence of neuronal damage in different distributions in the basal ganglia and brainstem.

Index terms: Basal ganglia, 142.891 • Basal ganglia, MR, 142.12145 • Brain, diseases, 142.891, 1538.891 • Brain, MR, 142.12145, 1538.12145 • Brain stem, abnormalities, 1538.891 • Brain stem, MR, 1538.12145 • Epidemiology • Magnetic resonance (MR), spectroscopy, 142.12145, 1538.12145

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