Fig. 2.

Brain MRS findings of the patient. (A and B) Brain MRS on the third day of admission (A: left white matter; B: left basal ganglia) revealed a peak at 2.2 ppm, which was assumed to be the ketone body spectrum. Elevation of glutamine level, mild reduction of NAA level in the white matter, marked elevation of lactate level, and a decrease in NAA level in the basal ganglia were also observed. (C and D) MRS on the 11th day of admission (C: left white matter, D: left basal ganglia) showing disappearance of the ketone body peak in the white matter and basal ganglia.

MRS, magnetic resonance spectroscopy; NAA, N-acetylaspartate; Cho, choline; Cr, creatine; Gln, glutamine; Lac, lactate.