NUCLEAR-MAGNETIC-RESONANCE CHARACTERIZATION OF SECONDARY MECHANISMS FOLLOWING TRAUMATIC BRAIN INJURY

Much of the injury that occurs following a traumatic insult to the cen tral nervous system is the result of physiological and biochemical pro cesses initiated by the primary traumatic event. These processes occur over a period of hours to days following the insult, and although a n umber of factors have been identified as being associated with this se condary injury process, their role and interrelationship with one anot her is unclear. Nuclear magnetic resonance spectroscopy has been utili zed to characterize many of these secondary factors and their relation ship to eventual neurological outcome. In particular, the role of high energy phosphates, pH, lactic acid, excitatory amino acids, and magne sium has been investigated, along with pharmacotherapies directed towa rd altering the status of these factors following traumatic injury. Th is review critically examines the role that each of these factors may play in the secondary injury process, and proposes a scheme which theo retically accounts for the interrelationships among the various factor s.