title: Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome.
abstract: BACKGROUND
  Conventional MRI can provide critical information for care of patients with traumatic brain injury (TBI), but MRI abnormalities rarely correlate to clinical severity and outcome. Previous magnetic resonance spectroscopy studies have reported clinically relevant brain metabolic changes in patients with TBI. However, these changes were often assessed a few to several days after the trauma, with a consequent variation of the metabolic pattern due to temporal changes.
  
  
  METHODS
  Proton magnetic resonance spectroscopic imaging (1H-MRSI) examinations were performed in 10 patients with TBI 48-72 h after the trauma, to obtain early measurements of central brain levels of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and lactate (La). Metabolite values were expressed as ratios to (1) a metabolic pattern, given by the sum of the resonance intensities of all metabolites detected in the same voxel and (2) intravoxel Cr.
  
  
  RESULTS
  NAA ratios were found to be significantly lower in patients with TBI than in normal controls. In contrast, Cho ratios were significantly higher in patients with TBI than in normal controls. Increased La levels were found in 5 of 10 patients with TBI. Both NAA and La values correlated closely with those of the Glasgow Coma Scale at presentation (r = 0.73 and -0.62, respectively; p<0.01 for both) and the Glasgow Outcome Scale at 3 months (r = -0.79 and 0.79, respectively; p<0.01 for both).
  
  
  CONCLUSIONS
  Spectroscopic measures of neuro-axonal damage occurring soon after a brain trauma are clinically relevant. Significant increases in cerebral La level also may be detected when 1H-MRSI is performed early after the trauma and, at this stage, can represent a reliable index of injury severity and disease outcome in patients with TBI.
authors.affiliation: Department of Neurological and Behavioural Sciences, University of Siena, Viale Bracci 2, 53100 Siena, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Marino
authors.forename: Ettore
authors.initials: E
authors.lastname: Zei
authors.forename: Marco
authors.initials: M
authors.lastname: Battaglini
authors.forename: Cesare
authors.initials: C
authors.lastname: Vittori
authors.forename: Antonella
authors.initials: A
authors.lastname: Buscalferri
authors.forename: Placido
authors.initials: P
authors.lastname: Bramanti
authors.forename: Antonio
authors.initials: A
authors.lastname: Federico
authors.forename: Nicola
authors.initials: N
authors.lastname: De Stefano
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000378:metabolism*; D001930:Brain Injuries / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome