Nonaccidental head trauma (NAHT) in infants and children involves intentional injury that is often associated with severe neurological and neuropsychological sequelae. Injuries due to NAHT result in immediate changes in neural function, as evidenced by abnormal biochemical metabolite levels and clinical variables, which are predictive of long-term outcome. Identification of the association between biochemical metabolite levels and clinical variables with long-term outcome of NAHT would permit for an understanding of the types of services that could potentially facilitate recovery or reduce the severity of impairment. Infants and children who sustain such injuries are often excluded from the abuse as well as close head injury literature. Consequently, there is a limited understanding of the predictors of neuropsychological sequelae in this population. Proton Magnetic Resonance Spectroscopy (1H-MRS) provides a promising, quantitative technique by which biochemical substrate levels that result from head injury may predict long term neuropsychological sequelae.

The purpose of this study was to assess the degree to which 1H-MRS metabolite levels increase the predictive validity of the severity of neuropsychological outcome above and beyond clinical predictors alone. Infants and children who were treated for head injury related specifically to nonaccidental trauma at Loma Linda University Children’s Hospital were recruited for this study. Results suggested associations between Glasgow Coma Score, duration of impaired consciousness, and NAA/Cre ratios with outcome scores for infants. Levels of NAA/Cre were reduced in the NAHT as compared to control groups. However, lactate did not significantly differ between the NAHT and control groups. Glx, total Cho/Cre, and corpus Callosum Cho/Cre and NAA/Cho predicted outcomes in older children. Future studies should examine these associations to determine whether metabolite ratios could be used as an additional criterion in understanding and diagnosing traumatic stress in infants and children. 1H-MRS variables must continue to be examined for their potential significant prediction of long term neuropsychological outcomes for infants and children who suffer NAHT.

LLU Discipline





Graduate School

First Advisor

Kiti Freier

Second Advisor

Stephen Ashwal

Third Advisor

Todd Burley

Fourth Advisor

Barbara Holshouser

Fifth Advisor

Matt Riggs

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Subject - Local

Head Injuries, Closed -- in infancy and childhood; Magnetic Resonance Spectroscopy; Neuropsychology -- in infancy and childhood; Child Abuse -- psychology.



Page Count

xvi; 251

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives