Fig. 1

Simplified scheme of cerebral glucose metabolism. In aerobic circumstances glucose is converted into pyruvate and enters the tricarboxylic acid (TCA) cycle/oxidative phosphorylation, resulting in ATP production. Through the creatine kinase (CK) reaction, adenosine diphosphate (ADP) can be rephosphorylated, with conversion from phosphocreatine (PCr) to Cr. When aerobic energy metabolism is insufficient, there can be a switch to anaerobic glycolysis, resulting in an accumulation of Lac, enzymatically converted by Lac dehydrogenase (LDH)