31P-MRS Reveals Brain-Wide Energy Crisis After Aneurysmal SAH, Worse with Vasospasm

Pilot 31P-MRS study of 21 aneurysmal SAH patients shows brain-wide impaired ATP turnover and membrane metabolism (all P<0.01) in subacute phase, worse with vasospasm. Suggests vasospasm amplifies preexisting energy crisis.

• Compared to healthy controls, aSAH patients had significantly reduced PCr/ATP and Pi/ATP, increased PCr/Pi, and altered PME/PDE across all brain territories (all P<0.01).
• Metabolic abnormalities were more pronounced in patients with cerebral vasospasm, indicating that vasospasm amplifies a preexisting global bioenergetic crisis.
• Single-center pilot study with limited sample size (N=21) and no external validation.

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