Acta Neurochirurgica

, Volume 115, Issue 3–4, pp 106–111 | Cite as

Increased serum creatine kinase BB and neuron specific enolase following head injury indicates brain damage

  • I. M. Skogseid
  • H. K. Nordby
  • P. Urdal
  • E. Paus
  • F. Lilleaas
Clinical Research

Summary

The aim of this study was to examine whether an increase in the serum concentrations of the two brain enzymes creatine kinase BB (CK-BB) and neuron specific enolase (NSE) can be demonstrated in patiens with acute head injury and whether such an increase reflects release from damaged brain tissue. In 60 patients who had suffered minor to severe head injury, serial blood samples were drawn during the first hours after impact, and CK-BB and NSE were measured by radio-immuno-assay. Computed tomography (CT) was also performed shortly after admission to hospital, and was repeated 1–3 days later in selected patients.

Increased serum concentrations of both CK-BB and NSE were found in 88% of the patients with moderate to severe head injury (group 1, n=18) and in 23% of the patients with minor head injury (group 2, n=42), whereas CT showed contusion in only 41% and 2% of the group 1 and 2 patients, respectively. The following findings suggest that the enzymes had been released from brain tissue:

  1. 1)

    The maximum concentrations of CK-BB and NSE correlated with the severity of injury as assessed clinically and with the volume of contusion as estimated from CT (r=0.79 with CK-BB, r=0.72 with NSE).

     
  2. 2)

    The maximum concentrations of CK-BB and NSE were closely correlated (r=0.87).

     
  3. 3)

    The ratio between CK-BB and NSE was approximately the same in a subgroup of 10 patients with multiple trauma as in the group as a whole (median 2.2 versus 2.0).

     

Measurements of the serum concentrations of CK-BB and NSE in patients with acute head trauma, therefore, appears to provide information about the presence and, to some degree, extent of the resulting brain injury. Further studies are required to reveal the value of such measurements in the management of patients with acute head trauma.

Keywords

Creatine kinase BB neuron specific enolase computed tomography traumatic damage 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bakay RAE, Sweeney KM, Wood JH (1986) Pathophysiology of cerebrospinal fluid in head injury. Part 2: Biochemical markers for central nervous system trauma. Neurosurgery 18: 376–382PubMedGoogle Scholar
  2. 2.
    Bakay RAE, Ward AA (1983) Enzymatic changes in serum and cerebrospinal fluid in neurological injury. J Neurosurg 58: 27–37PubMedGoogle Scholar
  3. 3.
    Chandler WL, Fine JS, Emery Met al. (1988) Regional creatine kinase., adenylate kinase, and lactate dehydrogenase in a normal canine brain. Stroke 19: 251–255PubMedGoogle Scholar
  4. 4.
    Cooper PR, Chalif DJ, Ramsey JSet al. (1983) Radioimmunoassay of the brain type isoenzyme of creatine phosphokinase (CK-BB): A new diagnostic tool in the evaluation of patients with head injury. Neurosurgery 12: 536–541PubMedGoogle Scholar
  5. 5.
    Hans P, Albert A, Franssen Cet al. (1989) Improved outcome prediction based on CSF extrapolated creatine kinase BB isoenzyme activity and other risk factors in severe head injury. J Neurosurg 71: 54–58PubMedGoogle Scholar
  6. 6.
    Hans P, Born JD, Chapelle JPet al. (1983) Creatine kinase iso-enzymes in severe head injury. J Neurosurg 58: 689–692PubMedGoogle Scholar
  7. 7.
    Hårdemark HG, Ericsson N, Kotwica Zet al. (1989) S-100 protein and neuron-specific enolase in CSF after experimental traumatic of focal ischemic brain damage. J Neurosurg 71: 727–731PubMedGoogle Scholar
  8. 8.
    Jenkins A, Teasdale G, Hadley MDMet al. (1986) Brain Lesions detected by Magnetic Resonance Imaging in Mild and Severe Head Injuries. Lancet 2: 445–446PubMedGoogle Scholar
  9. 9.
    Kaste M, Hernesniemi J, Somer Het al. (1981) Creatine kinase isoenzymes in acute brain injury. J Neurosurg 55: 511–515PubMedGoogle Scholar
  10. 10.
    Levin HS, Amparo E, Eisenberg HMet al. (1987) Magnetic resonance imaging and computerized tomography in relation to the neurobehavioural sequelae of mild and moderate head injuries. J Neurosurg 66: 706–713PubMedGoogle Scholar
  11. 11.
    Lobato RD, Sarabia R, Rivas JJet al. (1986) Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications. J Neurosurg 65: 784–789PubMedGoogle Scholar
  12. 12.
    Niedeggen A, Adelt D, Berndt Ret al. (1986) Creatine-kinase-BB after severe head injury as an index of prognosis in relation to nature of trauma and patients age. Acta Neurochir (Wien) 101: 117–120Google Scholar
  13. 13.
    Nordby HK, Urdal P (1985) Creatine kinase BB in blood as index of prognosis and effect of treatment after severe head injury. Acta Neurochir (Wien) 76: 131–136Google Scholar
  14. 14.
    Nordby HK, Urdal P (1982) The diagnostic value of measuring creatine kinase BB activity in cerebrospinal fluid following acute head injury. Acta Neurochir (Wien) 65: 93–101Google Scholar
  15. 15.
    Paus E, Nustad K (1989) Immunoradiometric assay for α- and γ- enolase (neuron specific enolase), with use of monoclonal antibodies and magnetizable polymer particles. Clin Chem 35: 2034–2038PubMedGoogle Scholar
  16. 16.
    Phillips JP, Jones HM, Hitchcock Ret al. (1980) Radioimmunoassay of serum creatine kinase BB as index of brain damage after head injury. Br Med J 281: 777–779PubMedGoogle Scholar
  17. 17.
    Rabow L, Cook M, Lipper MHet al. (1989) Relationship between CT attenuation changes and post-traumatic CSF-CKBB-activity after severe head injury in man. Acta Neurochir (Wien) 100: 155–157Google Scholar
  18. 18.
    Rabow L, Hedman G (1985) Creatine kinase BB-activity after head trauma related to outcome. Acta Neurochir (Wien) 76: 137–139Google Scholar
  19. 19.
    Schwartz JG, Bazan C, Gage Cet al. Serum creatine kinase isoenzyme BB is a poor index to the size of various brain lesions. Clin Chem 35: 651–654Google Scholar
  20. 20.
    Teasdale G, Jennet B (1974) Assessment of coma and impaired consciousness, A partical scale. Lancet 2: 81–84PubMedGoogle Scholar
  21. 21.
    Urdal P, Kierulf P (1981) Sensitive and Specific Radioimmunoassay for Creatine Kinase Isoenzyme in Serum, with use of an Autoantibody. Clin Chem 27: 83–87PubMedGoogle Scholar
  22. 22.
    Urdal P, Urdal K, Strømme JH (1983). Cytoplasmic Creatine Kinase Isoenzymes Quantitated in Tissue Specimens obtained at Surgery. Clin Chem 29: 310–313PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • I. M. Skogseid
    • 1
  • H. K. Nordby
    • 1
  • P. Urdal
    • 2
  • E. Paus
    • 4
  • F. Lilleaas
    • 3
  1. 1.Department of NeurosurgeryUllevål HospitalNorway
  2. 2.Department of Clinical ChemistryUllevål HospitalNorway
  3. 3.Department of NeuroradiologyUllevål HospitalNorway
  4. 4.Central LaboratoryThe Norwegian Radium HospitalOsloNorway

Personalised recommendations