Evidence From Proton Magnetic Resonance Spectroscopy for a Metabolic Cascade of Neuronal Damage in Shaken Baby Syndrome

• DOI: 10.1542/peds.99.1.4
• Publication Date: 2004-08-13T22:12:21Z
• Authors: Luke J. Haseler; Edgardo Arcinue; Else R. Danielsen; Stefan Bluml; Brian D. Ross
• Keywords: Creatine; Abnormality; Brain damage

Objective. The purpose of this study was to use proton magnetic resonance spectroscopy (MRS) as a metabolic assay describe biochemical changes during the evolution neuronal injury in infants after shaken baby syndrome (SBS), that explain disparity between apparent physical and neurological deficit SBS. Methodology. Three [6 months (A), 5 weeks (B), 7 (C)] with SBS were examined repeatedly using localized quantitative MRS. Examinations performed on days 13 1, 3, 5, 12 19 (C) posttrauma. Long-term follow-up examinations posttrauma (A) 4.6 (B). Data compared control data from 52 neurologically normal presented previous study. Results. Spectra parietal white matter obtained at approximately same time (5 days) showed markedly different patterns abnormality. Infant A shows near levels marker N-acetyl aspartate, creatine, phosphocreatine, although infant C absent almost creatine great excess lactate/lipid lipid. Analysis course B appears connect these variations markers severity head suffered abuse, indicating progression principal cerebral metabolites detected by MRS remain up 24 hours fall precipitately ∼40% within days, lipid more than doubling concentration 12. Conclusions. strong impression is gained prognostic because recovered remained state consistent compromised capacity. Loss integrity MR spectrum signal irreversible damage occurs when clinical status gives no indication long-term outcome. These results suggest value sequential management