Acta Neurochirurgica

, Volume 139, Issue 1, pp 26–32 | Cite as

Neuropsychological function in patients with increased serum levels of protein S-100 after minor head injury

  • K. Waterloo
  • T. Ingebrigtsen
  • B. Romner
Clinical Articles


Protein S-100 is a calcium binding protein, synthetized in astroglial cells in all parts of the central nervous system (CNS). We have previously reported high serum levels of protein S-100 in patients after minor head injury (MHI). A battery of conventional and computerized neuropsychological measures was administered to two groups of MHI patients. Neuropsychological outcome at 12 months postinjury was examined in a group of 7 patients with increased serum levels of protein S-100 after MHI and 7 age- and sex-matched controls without detectable S-100 in serum after MHI. Our results demonstrate no overall cognitive dysfunction in either of the two groups. Our findings indicate specific dysfunction on measures of reaction time, attention and speed of information processing for the S-100 group. Posttraumatic depression does not explain the neuropsychological differences between the groups. These findings support that increased serum levels of protein S-100 may be of predictive and prognostic value for longlasting neurocognitive abnormalities after minor head injury. Presence of S-100 in serum may indicate the presence of diffuse brain damage. Our results suggest that information processing measures in computerized neuropsychological assessment are more sensitive for detecting small signs of neurocognitive abnormalities after MHI than conventional test batteries.


Head injury protein S-100 cognitive dysfunction 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Aurell A, Rosengren LE, Karlsson B,et al (1991) Determination of S-100 and glial fibrillary acidic protein concentrations in cerebrospinal fluid after brain infarction. Stroke 22: 1254–1258PubMedGoogle Scholar
  2. 2.
    Aurell A, Rosengren LE, Wikkelsø C,et al (1989) The S-100 protein in cerebrospinal fluid; a simple ELISA method. J Neurol Sci 89: 157–164PubMedGoogle Scholar
  3. 3.
    Earth JT, Macciocchi SN, Giordani B,et al (1983) Neuropsychological sequelae of minor head injury. Neurosurgery 13: 529–533PubMedGoogle Scholar
  4. 4.
    Bassett SS, Slater EJ (1990) Neuropsychological function in adolescents sustaining mild closed head injury. J Pediatric Psychol 15: 225–236Google Scholar
  5. 5.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4: 561–571PubMedGoogle Scholar
  6. 6.
    Dikmen SS, Reitan RM, Temkin NR (1983) Neuropsychological recovery in head injury. Arch Neurol 40: 333–338PubMedGoogle Scholar
  7. 7.
    Dikmen SS, Machamer JE, Winn HR, Temkin NR (1995) Neuropsychological outcome at 1-year post head injury. Neuropsychologica 9: 80–90Google Scholar
  8. 8.
    Edna TH (1987) Disability 3–5 years after minor head injury. J Oslo City Hosp 7: 41–48Google Scholar
  9. 9.
    Fagnart OC, Sindic CJM, Laterre C (1988) Particle counting immunoassay of S-100 protein in serum. Possible relevance in tumors and ischemic disorders of the central nervous system. Clin Chem 34: 1387–1391PubMedGoogle Scholar
  10. 10.
    Gandy SE, Snow RB, Zimmerman RD,et al (1984) Cranial nuclear magnetic resonance imaging in head trauma. Ann Neurol 16: 254–257PubMedGoogle Scholar
  11. 11.
    Gronwall D, Wrightson P (1974) Delayed recovery of intellectual function after minor head injury. Lancet ii: 2605–2609Google Scholar
  12. 12.
    Hall S, Bornstein RA (1991) The relationship between intelligence and memory following minor or mild closed head injury: greater impairment in memory than intelligence. J Neurosurg 75: 378–381PubMedGoogle Scholar
  13. 13.
    Ingebrigtsen T, Romner B, Kongstad P, Langbakk B (1995) Increased serum concentrations of protein S-100 after minor head injury: a biochemical serum marker with prognostic value? J Neurol Neurosurg Psychiatry 59: 103–104Google Scholar
  14. 14.
    Kato K, Nakajima T, Ishiguro Y, Matsutani T (1982) Sensitive enzyme immunoassay for S-100 protein: determination in human cerebrospinal fluid. Biomed Res 3: 24–28Google Scholar
  15. 15.
    Kelly R (1981) The posttraumatic syndrome. Royal Soc Med 74: 242–244Google Scholar
  16. 16.
    Leininger BE, Gramling SE, Farrell AD,et al (1990) Neuropsychological deficits in symptomatic minor head injury after concussion and mild concussion. J Neurol Neurosurg Psychiatry 53: 293–296PubMedGoogle Scholar
  17. 17.
    Levin HS, Amparo E, Eisenberg,et al (1992) The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma 33: 385–394PubMedGoogle Scholar
  18. 18.
    Levin HS, Eisenberg HM, Benton AL (eds) (1989) Mild head injury. Oxford University Press, New York, NYGoogle Scholar
  19. 19.
    Levin HS (1992) Neurobehavioral recovery. J Neurotrauma 9 [Suppl 1]: S359-S373PubMedGoogle Scholar
  20. 20.
    Levin HS, Grafman J, Eisenberg HM (eds) (1987) Neurobehavioral recovery from head injury. Oxford University Press, New York, NYGoogle Scholar
  21. 21.
    Lezak MD (1995) Neuropsychiological assessment, 3rd Ed. Oxford University Press, New York, NYGoogle Scholar
  22. 22.
    Lezak MD (ed) (1989) Assessment of the behavioral consequences of head trauma. In: Lezak MD (ed) Clinical neuroscience, Vol 7. Liss, New York, NYGoogle Scholar
  23. 23.
    Michetti F, Massaro A, Murazio M (1979) The nervous system specific S-100 antigen in cerebrospinal fluid of multiple sclerosis patients. Neurosci Lett 11: 171–175PubMedGoogle Scholar
  24. 24.
    Michetti F, Massaro A, Russo G, Rigon G (1980) The S-100 antigen in cerebrospinal fluid as a possible index of cell injury in the central nervous system. J Neurol Sci 44: 259–263PubMedGoogle Scholar
  25. 25.
    Middelboe T, Andersen HS, Birket-Smith M, Friis ML (1992) Minor head injury: impact on general health after 1 year. A prospective follow-up study. Acta Neurol Scand 85: 5–9PubMedGoogle Scholar
  26. 26.
    Miller EN (1993) CalCAP. California computerized Assessment package manual. Los Angeles, Norland SoftwareGoogle Scholar
  27. 27.
    Miller EN, Satz P, Visscher B (1991) Computerized and conventional neuropsychiological assessment of HIV-1-infected homosexual men. Neurology 41: 1608–1616PubMedGoogle Scholar
  28. 28.
    Mokuno K, Kato K, Kawai K,et al (1983) Neuron-specific enolase and S-100 protein levels in cerebrospinal fluid of patients with various neurological diseases. J Neurol Sci 60: 443–451PubMedGoogle Scholar
  29. 29.
    Nestvold K, Lundar T, Blikra G, Lønnum A (1988) Head injuries during one year in a central hospital in Norway: a prospective study. Neuroepidemiology 7: 134–144PubMedGoogle Scholar
  30. 30.
    Noppe M, Crols R, Andries D, Lowenthal A (1986) Determination in human cerebrospinal fluid of glial fibrillary acidic protein, S-100 and myelin basic protein as indices of non-specific or specific nervous tissue pathology. Clin Chim Acta 155: 143–150PubMedGoogle Scholar
  31. 31.
    Oppenheimer DR (1968) Microscopic lesions in the brain following head injury. J Neurol Neurosurg Psychiatry 31: 299–306PubMedGoogle Scholar
  32. 32.
    Persson L, Hårdemark H, Edner G,et al (1988) S-100 protein in cerebrospinal fluid of patients with subarachnoid haemorrhage: a potential marker of brain damage. Acta Neurochir (Wien) 93: 116–122Google Scholar
  33. 33.
    Persson L, Hårdemark HG, Gustafsson J,et al (1987) S-100 protein and neuron-specific-enolase in cerebrospinal fluid and serum. Markers of cell damage in human central nervous tissue. Stroke 18: 911–918PubMedGoogle Scholar
  34. 34.
    Povlishock JT, Becker DP, Cheng CLY, Vaughan GW (1983) Axonal change in minor head injury. J Neuropath Exp Neurol 42: 225–242PubMedGoogle Scholar
  35. 35.
    Reitan RM, Davidson LA (eds) (1974) Clinical neuropsychology: current status and applications. Wiley, Washington, DCGoogle Scholar
  36. 36.
    Reitan RM, Wolfson D (1993) The Halstead-Reitan neuropsy-chological test battery. Theory and clinical interpretation, 2nd Ed. Neuropsychology Press, Tucson, AZGoogle Scholar
  37. 37.
    Robinson AL, Heaton RK, Lehman RAW, Stilson DW (1980) The utility of the Wisconsin Card Sorting Test in detecting and localizing frontal lobe lesions. J Consult Clin Psychol 48: 605–614PubMedGoogle Scholar
  38. 38.
    Rutherford WH, Merret JD, McDonald JR (1979) Symptoms at one year following concussion from minor head injury. Injury 10: 225–230PubMedGoogle Scholar
  39. 39.
    Sindic CJM, Chalon MP, Cambiaso CL,et al (1982) Assessment of damage to the central nervous system by determination of S-100 protein in the cerebrospinal fluid. J Neurol Neurosurg Psychiatry 45: 1130–1135PubMedGoogle Scholar
  40. 40.
    Stuss DT, Stethem LL, Hugenholtz R,et al (1989) Reaction time after head injury: fatigue, divided and focused attention, and consistency of performance. J Neurol Neurosurg Psychiatry 52: 752–758Google Scholar
  41. 41.
    Stuss DT, Ely P, Hugenholtz R,et al (1985) Subtle neuropsychological deficits in patients with good recovery after closed head injury. Neurosurgery 17: 41–47PubMedGoogle Scholar
  42. 42.
    Van Gorp WG, Miller EN, Marcotte TD,et al (1994) The relationship between age and cognitive impairment in HIV-1 infection: findings from the multicenter AIDS cohort study and a clinical cohort. Neurology 44: 929–935PubMedGoogle Scholar
  43. 43.
    Van Zomeren AH, Deelman BG (1978) Long term recovery of visual reaction time after closed head injury. J Neurol Neurosurg Psychiatry 41: 452–457PubMedGoogle Scholar
  44. 44.
    Van Zomeren AH, Brouwer WH (1994) Clinical neuropsychology of attention. Oxford University Press, New York, NYGoogle Scholar
  45. 45.
    Wechsler D (1987) Manual for the memory scale revisited. The Psychological Corporation, San Antonio, TXGoogle Scholar
  46. 46.
    Wetzel JW (1984) Clinical handbook of depression. Gardener, New YorkGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • K. Waterloo
    • 1
  • T. Ingebrigtsen
    • 2
  • B. Romner
    • 3
  1. 1.Department of NeurologyUniversity Hospital of TromsøNorway
  2. 2.Department of NeurosurgeryUniversity Hospital of TromsøNorway
  3. 3.Department of NeurosurgeryUniversity Hospital of LundSweden

Personalised recommendations