Nuclear magnetic resonance characterization of secondary mechanisms following traumatic brain injury

Much of the injury that occurs following a traumatic insult to the central nervous system is the result of physiological and biochemical processes initiated by the primary traumatic event. These processes occur over a period of hours to days following the insult, and although a number of factors have been identified as being associated with this secondary injury process, their role and interrelationship with one another is unclear. Nuclear magnetic resonance spectroscopy has been utilized to characterize many of these secondary factors and their relationship to eventual neurological outcome. In particular, the role of high energy phosphates, pH, lactic acid, excitatory amino acids, and magnesium has been investigated, along with pharmacotherapies directed toward altering the status of these factors following traumatic injury. This review critically examines the role that each of these factors may play in the secondary injury process, and proposes a scheme which theoretically accounts for the interrelationships among the various factors.