Skip to main content
SpringerLink
Log in

Traumatic Brain Injury and Concussion

  • Chapter
  • First Online:
MR Spectroscopy of Pediatric Brain Disorders

  • 2002 Accesses

Abstract

Imaging modalities such as CT and magnetic resonance imaging (MRI) are powerful tools to detect and assess focal injury such as hemorrhagic lesions and edema and brain swelling in severe injury. However, acute and chronic injury at a cellular level is sometimes difficult to discern from normal features by anatomical imaging. Magnetic resonance spectroscopy (MRS) offers a unique noninvasive approach to assess injury at microscopic levels by quantifying cellular metabolites. The findings obtained with MRS in concussion and more severe head trauma are heterogeneous, reflecting the different time after injury, degree of injury and different physiologic and pathologic response of the brain to injury in individuals. The most important findings are that elevated lactate (and lipids) in apparently normal tissue observed 2–5 days after injury are indicators of severe global hypoxic injury and poor outcome. Also, N-acetylaspartate (NAA), a marker for “healthy” neurons and axons, is generally reduced in traumatic brain injury signaling neuronal and axonal loss/damage. The extent of NAA reduction after injury is an objective and quantitative surrogate marker for the severity of injury and is useful for outcome prediction. In the cases of mild traumatic brain injury, choline (Cho) has been shown to be reflective of diffuse axonal injury and alterations in neurotransmitters such as glutamate (Glu) and gamma amino butyric acid (GABA) have also been shown.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Langlois JA, Rutland-Brown W, Thomas KE. The incidence of traumatic brain injury among children in the United States: differences by race. J Head Trauma Rehabil. 2005;20(3):229–38.

    Article  PubMed  Google Scholar 

  2. Brooks WM, Friedman SD, Gasparovic C. Magnetic resonance spectroscopy in traumatic brain injury. J Head Trauma Rehabil. 2001;16(2):149–64.

    Article  PubMed  CAS  Google Scholar 

  3. Govindaraju V, Gauger GE, Manley GT, Ebel A, Meeker M, Maudsley AA. Volumetric proton spectroscopic imaging of mild traumatic brain injury. AJNR Am J Neuroradiol. 2004;25(5):730–7.

    PubMed  Google Scholar 

  4. Macmillan CS, Wild JM, Wardlaw JM, Andrews PJ, Marshall I, Easton VJ. Traumatic brain injury and subarachnoid hemorrhage: in vivo occult pathology demonstrated by magnetic resonance spectroscopy may not be “ischaemic”. A primary study and review of the literature. Acta Neurochir (Wien). 2002;144(9):853–62. discussion 862.

    Article  CAS  Google Scholar 

  5. Brooks WM, Stidley CA, Petropoulos H, et al. Metabolic and cognitive response to human traumatic brain injury: a quantitative proton magnetic resonance study. J Neurotrauma. 2000;17(8):629–40.

    Article  PubMed  CAS  Google Scholar 

  6. Gasparovic C, Arfai N, Smid N, Feeney DM. Decrease and recovery of N-acetylaspartate/creatine in rat brain remote from focal injury. J Neurotrauma. 2001;18(3):241–6.

    Article  PubMed  CAS  Google Scholar 

  7. Schuhmann MU, Stiller D, Skardelly M, Thomas S, Samii M, Brinker T. Long-time in-vivo metabolic monitoring following experimental brain contusion using proton magnetic resonance spectroscopy. Acta Neurochir Suppl. 2002;81:209–12.

    PubMed  CAS  Google Scholar 

  8. Magistretti PJ, Pellerin L, Rothman DL, Shulman RG. Energy on demand. Science. 1999;283(5401):496–7.

    Article  PubMed  CAS  Google Scholar 

  9. Signoretti S, Marmarou A, Tavazzi B, Lazzarino G, Beaumont A, Vagnozzi R. N-Acetylaspartate reduction as a measure of injury severity and mitochondrial dysfunction following diffuse traumatic brain injury. J Neurotrauma. 2001;18(10):977–91.

    Article  PubMed  CAS  Google Scholar 

  10. Miller BL. A review of chemical issues in 1 H NMR spectroscopy: N-acetyl-L-aspartate, creatine and choline. NMR Biomed. 1991;4(2):47–52.

    Article  PubMed  CAS  Google Scholar 

  11. Jope RS, Jenden DJ. Choline and phospholipid metabolism and the synthesis of acetylcholine in rat brain. J Neurosci Res. 1979;4(1):69–82.

    Article  PubMed  CAS  Google Scholar 

  12. Brand A, Richter-Landsberg C, Leibfritz D. Multinuclear NMR studies on the energy metabolism of glial and neuronal cells. Dev Neurosci. 1993;15(3–5):289–98.

    Article  PubMed  CAS  Google Scholar 

  13. Badar-Goffer RS, Ben-Yoseph O, Bachelard HS, Morris PG. Neuronal-glial metabolism under depolarizing conditions. A 13C-n.m.r. study. Biochem J. 1992;282(Pt 1):225–30.

    PubMed  CAS  Google Scholar 

  14. Pfefferbaum A, Adalsteinsson E, Spielman D, Sullivan EV, Lim KO. In vivo spectroscopic quantification of the N-acetyl moiety, creatine, and choline from large volumes of brain gray and white matter: effects of normal aging. Magn Reson Med. 1999; 41(2):276–84.

    Article  PubMed  CAS  Google Scholar 

  15. Ross BD, Ernst T, Kreis R, et al. 1 H MRS in acute traumatic brain injury. J Magn Reson Imaging. 1998;8(4):829–40.

    Article  PubMed  CAS  Google Scholar 

  16. Garnett MR, Blamire AM, Corkill RG, Cadoux-Hudson TA, Rajagopalan B, Styles P. Early proton magnetic resonance spectroscopy in normal-appearing brain correlates with outcome in patients following traumatic brain injury. Brain. 2000;123(Pt 10):2046–54.

    Article  PubMed  Google Scholar 

  17. Holshouser BA, Ashwal S, Shu S, Hinshaw Jr DB. Proton MR spectroscopy in children with acute brain injury: comparison of short and long echo time acquisitions. J Magn Reson Imaging. 2000;11(1):9–19.

    Article  PubMed  CAS  Google Scholar 

  18. Friedman SD, Brooks WM, Jung RE, et al. Quantitative proton MRS predicts outcome after traumatic brain injury. Neurology. 1999;52(7):1384–91.

    Article  PubMed  CAS  Google Scholar 

  19. Ricci R, Barbarella G, Musi P, Boldrini P, Trevisan C, Basaglia N. Localised proton MR spectroscopy of brain metabolism changes in vegetative patients. Neuroradiology. 1997;39(5):313–9.

    Article  PubMed  CAS  Google Scholar 

  20. Holshouser BA, Ashwal S, Luh GY, et al. Proton MR spectroscopy after acute central nervous system injury: outcome prediction in neonates, infants, and children. Radiology. 1997;202(2):487–96.

    PubMed  CAS  Google Scholar 

  21. Haseler LJ, Arcinue E, Danielsen ER, Bluml S, Ross BD. Evidence from proton magnetic resonance spectroscopy for a metabolic cascade of neuronal damage in shaken baby syndrome. Pediatrics. 1997;99(1):4–14.

    Article  PubMed  CAS  Google Scholar 

  22. Condon B, Oluoch-Olunya D, Hadley D, Teasdale G, Wagstaff A. Early 1 H magnetic resonance spectroscopy of acute head injury: four cases. J Neurotrauma. 1998;15(8):563–71.

    Article  PubMed  CAS  Google Scholar 

  23. Holshouser BA, Tong KA, Ashwal S. Proton MR spectroscopic imaging depicts diffuse axonal injury in children with traumatic brain injury. AJNR Am J Neuroradiol. 2005;26(5):1276–85.

    PubMed  Google Scholar 

  24. Cecil KM, Hills EC, Sandel ME, et al. Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients. J Neurosurg. 1998;88(5):795–801.

    Article  PubMed  CAS  Google Scholar 

  25. Choe BY, Suh TS, Choi KH, Shinn KS, Park CK, Kang JK. Neuronal dysfunction in patients with closed head injury evaluated by in vivo 1 H magnetic resonance spectroscopy. Invest Radiol. 1995;30(8):502–6.

    Article  PubMed  CAS  Google Scholar 

  26. Shutter L, Tong KA, Holshouser BA. Proton MRS in acute traumatic brain injury: role for glutamate/glutamine and choline for outcome prediction. J Neurotrauma. 2004;21(12):1693–705.

    Article  PubMed  Google Scholar 

  27. Kay T, Harrington DE, et al. Definition of mild traumatic brain injury. J Head Trauma Rehabilitat. 1993;8(3):86–7.

    Article  Google Scholar 

  28. Lin A, Ross BD, Harris K, Wong W. Efficacy of proton magnetic resonance spectroscopy in neurological diagnosis and neurotherapeutic decision making. NeuroRx. 2005;2(2):197–214.

    Article  PubMed  Google Scholar 

  29. Kraus MF, Susmaras T, Caughlin BP, Walker CJ, Sweeney JA, Little DM. White matter integrity and cognition in chronic traumatic brain injury: a diffusion tensor imaging study. Brain. 2007;130(10):2508–19.

    Article  PubMed  Google Scholar 

  30. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.

    Article  PubMed  Google Scholar 

  31. Iverson GL, Gaetz M, Lovell MR, Collins MW. Cumulative effects of concussion in amateur athletes. Brain Inj. 2004;18(5):433–43.

    Article  PubMed  Google Scholar 

  32. Meehan 3rd WP, Bachur RG. Sport-related concussion. Pediatrics. 2009;123(1):114–23.

    Article  PubMed  Google Scholar 

  33. CDC. Nonfatal traumatic brain injuries from sports and recreation activities–United States, 2001–2005. MMWR. 2007;56(29):733–7.

    Google Scholar 

  34. Field M, Collins MW, Lovell MR, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr. 2003;142(5):546–53.

    Article  PubMed  Google Scholar 

  35. Cimatti M. Assessment of metabolic cerebral damage using proton magnetic resonance spectroscopy in mild traumatic brain injury. J Neurosurg Sci. 2006;50(4):83–8.

    PubMed  CAS  Google Scholar 

  36. Henry LC, Tremblay SB, Boulanger Y, Ellemberg D, Lassonde M. Neurometabolic changes in the acute phase following sports concussions correlate with symptom severity. J Neurotrauma. 2009;27:65–76.

    Article  Google Scholar 

  37. Vagnozzi R, Signoretti S, Tavazzi B, et al. Temporal window of metabolic brain vulnerability to concussion: A pilot 1 H-magnetic resonance spectroscopic study in concussed athletes-Part III. Neurosurgery. 2008;62(6):1286–96.

    Article  PubMed  Google Scholar 

  38. Belanger HG, Spiegel E, Vanderploeg RD. Neuropsychological performance following a history of multiple self-reported concussions: A meta-analysis. J Int Neuropsychol Soc. 2009;11:1–6.

    Article  Google Scholar 

  39. Omalu BI, Bailes J, Hammers JL, Fitzsimmons RP. Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: The role of the forensic pathologist. Am J Forensic Med Pathol. 2010;31:130–2.

    Article  PubMed  Google Scholar 

  40. McKee A, Cantu R, Nowinski C, et al. Chronic traumatic encephalopathy in athletes. J Neuropath and Exp Neurol. 2009;68:709–35.

    Article  Google Scholar 

  41. Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007;39(6):903–9.

    Article  PubMed  Google Scholar 

  42. Martland HS. PUNCH DRUNK. J Am Med Assoc. 1928;91(15):1103–7.

    Article  Google Scholar 

  43. Millspaugh J. Dementia Pugilistica. US Naval Medical Bulletin. 1937;35(3):297–303.

    Google Scholar 

  44. Ramadan S, Mountford CE. Two-dimensional magnetic resonance spectroscopy on biopsy and in vivo. In: Webb GA, editor. Annual reports on NMR spectroscopy, vol. 65. Burlington: Academic; 2009. p. 161–99.

    Google Scholar 

  45. Thomas MA, Hattori N, Umeda M, Sawada T, Naruse S. Evaluation of two-dimensional L-COSY and JPRESS using a 3 T MRI scanner: from phantoms to human brain in vivo. NMR Biomed. 2003;16(5):245–51.

    Article  PubMed  CAS  Google Scholar 

  46. Lin A, Ramadan S, Stanwell P, et al. In vivo L-COSY MR distinguishes glutamate from glutamine and shows neuropathic pain to cause a buildup of glutamine in the brain. Proc Int Soc Magn Reson Med. 2010;18:381.

    Google Scholar 

  47. Gopinath SP, Valadka AB, Goodman JC, Robertson CS. Extracellular glutamate and aspartate in head injured patients. Acta Neurochir. 2000;76:437–8.

    CAS  Google Scholar 

  48. Bullock R, Zauner A, Woodward JJ, et al. Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg. 1998;89(4):507–18.

    Article  PubMed  CAS  Google Scholar 

  49. Shohami E, Shapira Y, Yadid G, Reisfeld N, Yedgar S. Brain phospholipase A2 is activated after experimental closed head injury in the rat. J Neurochem. 1989;53(5):1541–6.

    Article  PubMed  CAS  Google Scholar 

  50. Nilsson P, Hillered L, Ponten U, Ungerstedt U. Changes in cortical extracellular levels of energy-related metabolites and amino acids following concussive brain injury in rats. J Cereb Blood Flow Metab. 1990;10(5):631–7.

    Article  PubMed  CAS  Google Scholar 

  51. Deutschman CS, Konstantinides FN, Raup S, Thienprasit P, Cerra FB. Physiological and metabolic response to isolated closed-head injury. Part 1: Basal metabolic state: correlations of metabolic and physiological parameters with fasting and stressed controls. J Neurosurg. 1986;64(1):89–98.

    Article  PubMed  CAS  Google Scholar 

  52. Cecil KM, Hills EC, Sandel ME, et al. Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients. J Neurosurg. 1998;88(5):795–801.

    Article  PubMed  CAS  Google Scholar 

  53. Garnett MR, Blamire AM, Rajagopalan B, Styles P, Cadoux-Hudson TAD. Evidence for cellular damage in normal-appearing white matter correlates with injury severity in patients following traumatic brain injury: a magnetic resonance spectroscopy study. Brain. 2000;123(7):1403–9.

    Article  PubMed  Google Scholar 

  54. Govindaraju V, Gauger GE, Manley GT, Ebel A, Meeker M, Maudsley AA. Volumetric proton spectroscopic imaging of mild traumatic brain injury. Am J Neuroradiol. 2004;25(5):730–7.

    PubMed  Google Scholar 

  55. Kirov I, Fleysher L, Babb JS, Silver JM, Grossman RI, Gonen O. Characterizing ‘mild’ in traumatic brain injury with proton MR spectroscopy in the thalamus: Initial findings. Vol 21: Informa Healthcare; 2007:1147–1154.

    Google Scholar 

  56. Cohen BA, Inglese M, Rusinek H, Babb JS, Grossman RI, Gonen O. Proton MR spectroscopy and MRI-volumetry in mild traumatic brain injury. Am J Neuroradiol. 2007;28(5):907–13.

    PubMed  CAS  Google Scholar 

  57. Nakabayashi M, Suzaki S, Tomita H. Neural injury and recovery near cortical contusions: a clinical magnetic resonance spectroscopy study. J Neurosurg. 2007;106(3):370–7.

    Article  PubMed  Google Scholar 

  58. Gasparovic C, Yeo R, Mannell M, et al. Neurometabolite concentrations in gray and white matter in mild traumatic brain injury: a 1H Magnetic resonance spectroscopy study. J Neurotrauma. 2009;26:1635–43.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Alexander P. Lin Ph.D.

  2. Department of Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Stefan Blüml Ph.D.

Authors
  1. Alexander P. Lin Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan Blüml Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Keck School of Medicine, Dept. Radiology, University of Southern California, Zonal Avenue 1975, Los Angeles, 90089-9034, California, USA

    Stefan Blüml

  2. , Dept. of Pediatric Radiology, Children's Hospital of Pittsburg of UPMC, Penn Avenue 4401, Pittsburgh, 15224, Pennsylvania, USA

    Ashok Panigrahy

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Lin, A.P., Blüml, S. (2013). Traumatic Brain Injury and Concussion. In: Blüml, S., Panigrahy, A. (eds) MR Spectroscopy of Pediatric Brain Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5864-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-5864-8_7

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-5863-1

  • Online ISBN: 978-1-4419-5864-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation