Brain abnormalities in Gulf War syndrome: Evaluation with H-1 MR spectroscopy

PURPOSE: To test for neuronal brain damage in the basal ganglia and brainst em in Gulf War veterans by using magnetic resonance (MR) spectroscopy. MATERIALS AND METHODS: Twenty-two Gulf War veterans with one of three facto r 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 th e pens. Syndromes 1-3 are described as "impaired cognition," "confusion-ata xia," and "central pain," respectively. RESULTS: The N-acetylaspartate-to-creatine (NAA/Cr) ratio, which reflects f unctional neuronal mass, was significantly lower in the basal ganglia and b rainstem of Gulf War veterans with the three syndromes than in those struct ures of the control subjects (P = .007). The finding was corroborated in th e 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 evi dence of neuronal damage in different distributions in the basal ganglia an d brainstem.