Longitudinal Changes in Magnetic Resonance Spectroscopy in Pediatric Concussion: A Pilot Study.

Nearly 20% of US adolescents report at least one lifetime concussion. Pathophysiologic models suggest that traumatic biomechanical forces caused by rotational deceleration lead to shear stress, which triggers a neurometabolic cascade beginning with excitotoxicity and leading to significant energy demands and a period of metabolic crisis for the injured brain. Proton magnetic resonance spectroscopy (H MRS) offers a means for non-invasive measurement of neurometabolic changes after concussion. Describe longitudinal changes in metabolites measured in the brains of adolescent patients with concussion. We prospectively recruited 9 patients ages 11 to 20 who presented to a pediatric Emergency Department within 24 h of concussion. Patients underwent MRI scanning within 72 h (acute, = 8), 2 weeks (subacute, = 7), and at approximately 1 year (chronic, = 7). Healthy, age and sex-matched controls were recruited and scanned once ( = 9). H MRS was used to measure N-acetyl-aspartate, choline, creatine, glutamate + glutamine, and myo-inositol concentrations in six regions of interest: left and right frontal white matter, posterior white matter and thalamus. There was a significant increase in total thalamus glutamate+glutamine/choline at the subacute ( = 0.010) and chronic ( = 0.010) time points, and a significant decrease in total white matter myo-inositol/choline ( = 0.030) at the chronic time point as compared to controls. There are no differences in H MRS measurements in the acute concussive period; however, changes in glutamate+glutamine and myo-inositol concentrations detectable by H MRS may develop beyond the acute period.