AUTHOR=Meyer Erin J. , Stout Jeffrey N. , Chung Ai Wern , Grant P. Ellen , Mannix Rebekah , Gagoski Borjan 

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

JOURNAL=Frontiers in Neurology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00556

DOI=10.3389/fneur.2019.00556

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> 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 (<sup>1</sup>H MRS) offers a means for non-invasive measurement of neurometabolic changes after concussion.</p><p><bold>Objective:</bold> Describe longitudinal changes in metabolites measured <italic>in vivo</italic> in the brains of adolescent patients with concussion.</p><p><bold>Methods:</bold> 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, <italic>n</italic> = 8), 2 weeks (subacute, <italic>n</italic> = 7), and at approximately 1 year (chronic, <italic>n</italic> = 7). Healthy, age and sex-matched controls were recruited and scanned once (<italic>n</italic> = 9). <sup>1</sup>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.</p><p><bold>Results:</bold> There was a significant increase in total thalamus glutamate+glutamine/choline at the subacute (<italic>p</italic> = 0.010) and chronic (<italic>p</italic> = 0.010) time points, and a significant decrease in total white matter myo-inositol/choline (<italic>p</italic> = 0.030) at the chronic time point as compared to controls.</p><p><bold>Conclusion:</bold> There are no differences in <sup>1</sup>H MRS measurements in the acute concussive period; however, changes in glutamate+glutamine and myo-inositol concentrations detectable by <sup>1</sup>H MRS may develop beyond the acute period.</p>