With an incidence of approximately 180/100,000 per year, traumatic brain injury (TBI) is the leading cause of death and acquired disability in individuals under 35 years of age. The present study utilized proton magnetic resonance spectroscopy (1H-MRS) and neuropsychological assessment to determine the contribution of regional neuronal injury and metabolic changes to cognitive deficits in pediatric patients following TBI. Eleven patients with TBI and ten normal controls completed a general neuropsychological assessment of cognitive function. In addition, 1H-MRS ratio measures of N-acetylaspartate (NAA+NAAG/Cre) and choline (Cho/Cre) were acquired for all subjects in a slice of parenchyma superior to the lateral ventricles, using a multi-voxel spectroscopic imaging (SI) technique. Group differences in NAA+NAAG/Cre and Cho/Cre were found; children with TBI had lower mean NAA+NAAG/Cre and higher mean Cho/Cre than controls. NAA+NAAG/Cre and Cho/Cre were negatively correlated in the TBI group, although not in controls, reflecting neuropathological processes following TBI in children. No evidence was found for anterior-posterior variability in neurometabolite concentrations in either group. Between-group differences were demonstrated in average neuropsychological test performance, with TBI patients performing more poorly than controls. NAA+NAAG/Cre and Cho/Cre were strongly related to neuropsychological test performance in TBI patients, but not in controls. The results of this study are discussed in terms of pathophysiological mechanisms and outcome prediction in pediatric TBI.
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