Introduction MRS; basic physics of MR; the clinical significance of metabolites; an introduction to clinical cases; clinical cases; degenerative disease - Alzheimer disease, dementia, Huntington's disease, Parkinson's disease; systemic diseases - liver disease, diabetes mellitus; osmolar abnormalities; trauma - SIADH, hyper-osmolar state, diffuse axonal injury, hypoxic injury; global hypoxia -vascular diseases, stroke, infarcts and non vascular focal hypoxia; focal lesions - ectopic grey matter, HIV related lesions, tumours and tuberculoma; multiple sclerosis and other inflammatory disease; paediatrics - abnormal development, Reyes syndrome, inborn errors of metabolism; xenobiotics - ethanol, propylene, glycol, mannitol; MRS patterns and referral guidelines.