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Role of Neuroprotein S-100B in the Diagnostic of Pediatric Mild Brain Injury

  • Annelie-Martina Weinberg
  • Christoph CastellaniEmail author
Focus on Pediatric Polytrauma

Abstract

Traumatic brain injury is one of the leading causes of death and disability in children and adolescents. Patients with moderate or severe lesions can be readily recognized clinically, require immediate radiologic diagnostics by computed tomography (CT) or magnetic resonance imaging (MRI), admission to intensive care units, and, in some cases, will go on to require neurosurgical intervention. Patients with mild traumatic brain injuries (MTBIs) are diagnostically challenging. Often, the event is unobserved and head injury can only be suspected. Clinical symptoms are unreliable and clinical findings from neurological examination have to be interpreted with care. As a small percentage of MTBI patients progress to have a life-threatening intracranial hemorrhage, the recognition of this group of patients and their judicious and timely management is, therefore, an important goal. Subjecting every MTBI patient to a cranial CT scanning results in high costs and unnecessary exposure to ionizing radiation. Admitting all MTBI patients for observation and performing CTs only in case of clinical deterioration is costly and a substantial drain on resources, not to mention the radiation exposure and a source of stress for the majority of patients. Current European guidelines for diagnostics and therapy in MTBI patients are only partially applicable to the pediatric population. This article reviews the clinical problem, treatment options and guidelines, as well as diagnostic tools, with special focus on neuroprotein S-100B in pediatric and adolescent patients with MTBIs.

Key Words

S-100B Children TBI Review Commotio cerebri 

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References

  1. 1.
    Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry 1996;60:362–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Jankowitz BT, Adelson PD. Pediatric traumatic brain injury: past, present and future. Dev Neurosci 2006;28:264–75.CrossRefPubMedGoogle Scholar
  3. 3.
    Vos PE, Battistin L, Birbamer G, Gerstenbrand F, Potapov A, Prevec T, Stepan ChA, Traubner P, Twijnstra A, Vecsei L, von Wild K. EFNS guideline on mild traumatic brain injury: report of an EFNS task force. Eur J Neurol 2002;9:207–19.CrossRefPubMedGoogle Scholar
  4. 4.
    Meerhoff SR, de Kruijk JR, Rutten J, Leffers P, Twijnstra A. De incidentie van traumatisch schedel- of hersenletsel in het adherentie gebied van het Academisch Ziekenhuis Maastricht in 1997. Ned Tijdschr Geneeskd 2000;144:1915–8.PubMedGoogle Scholar
  5. 5.
    Biberthaler P, Linsenmeier U, Pfeifer KJ, Kroetz M, Mussack T, Kanz KG, Hoecherl EF, Jonas F, Marzi I, Leucht P, Jochum M, Mutschler W. Serum S-100B concentration provides additional information for the indication of computed tomography in patients after minor head injury: a prospective multicenter study. Shock 2006;25:446–53.CrossRefPubMedGoogle Scholar
  6. 6.
    Eide PK. The relationship between intracranial pressure and size of cerebral ventricles assessed by computed tomography. Acta Neurochir 2003;145:171–9.CrossRefGoogle Scholar
  7. 7.
    Berger RP, Adelson PD, Pierce MC, Dulani T, Cassidy LD, Kochanek PM. Serum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children. J Neurosurg 2005;103:61–8.PubMedGoogle Scholar
  8. 8.
    Culotta VP, Sementilli ME, Gerold K, Watts CC. Clinicopathological heterogeneity in the classification of mild head injury. Neurossurgery 1996;38:245–50.CrossRefGoogle Scholar
  9. 9.
    Gómez PA, Lobato RD, Ortega JM, De La Cruz J. Mild head injury: differences in prognosis among patients with a Glasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT findings. Br J Neurosurg 1996;10:453–60.CrossRefPubMedGoogle Scholar
  10. 10.
    Stein SC. Management of minor closed head injury. Neurosurg Q 1996;6:108–15.CrossRefGoogle Scholar
  11. 11.
    Castellani C, Bimbashi P, Ruttenstock E, Sacherer P, Stojakovic T, Weinberg AM. Neuroprotein s-100B — a useful parameter in paediatric patients with mild traumatic brain injury? Acta Paediatr 2009;98:1607–12.CrossRefPubMedGoogle Scholar
  12. 12.
    Stiell IG, Lesiuk H, Wells GA, Coyle D, McKnight RD, Brison R, Clement C, Eisenhauer MA, Greenberg GH, Macphail I, Reardon M, Worthington J, Verbeek R, Rowe B, Cass D, Dreyer J, Holroyd B, Morrison L, Schull M, Laupacis A. Canadian CT head rule study for patients with minor head injury: methodology for phase II (validation and economic analysis). Ann Emerg Med 2001;38:317–22.CrossRefPubMedGoogle Scholar
  13. 13.
    Teasdale G, Gentleman D. Early management of patients with a head injury. SIGN. 2002;46. http://www.sign.ac.uk.
  14. 14.
    Cushman JG, Agarwal N, Fabian TC, Garcia V, Nagy KK, Pasquale MD, Salotto AG. Practice management guidelines for the management of mild traumatic brain injury: the EAST practice management guidelines work group. J Trauma 2001;51:1016–26.CrossRefPubMedGoogle Scholar
  15. 15.
    Shackford SR, Wald SL, Ross SE, Cogbill TH, Hoyt DB, Morris JA, Mucha PA, Pachter HL, Sugerman HJ, O’Malley K, et al. The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma 1992;33:385–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Stein SC, Burnett MG, Glick HA. Indications for CT scanning in mild traumatic brain injury: A cost-effectiveness study. J Trauma 2006;61:558–66.CrossRefPubMedGoogle Scholar
  17. 17.
    Masters SJ, McClean PM, Arcarese JS, Brown RF, Campbell JA, Freed HA, Hess GH, Hoff JT, Kobrine A, Koziol DF, et al. Skull X-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med 1987;316:84–91.CrossRefPubMedGoogle Scholar
  18. 18.
    Mendelow AD, Teasdale G, Jennett B, Bryden J, Hessett C, Murray G. Risks of intracranial haematoma in head injured adults. Br Med J (Clin Res Ed) 1983;287:1173–6.CrossRefGoogle Scholar
  19. 19.
    Nee PA, Hadfield JM, Yates DW, Faragher EB. Significance of vomiting after head injury. J Neurol Neurosurg Psychiatry 1999;66:470–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Hofman PA, Nelemans P, Kemerink GJ, Wilmink JT. Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis. J Neurol Neurosurg Psychiatry 2000;68:416–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000;343:100–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Bazarian JJ, Blyth B, Cimpello L. Bench to bedside: evidence for brain injury after concussion — looking beyond the computed tomography scan. Acad Emerg Med 2006;13:199–214.PubMedGoogle Scholar
  23. 23.
    Maier B, Maier-Hemming A, Lehnert M, Mutschler WE, Marzi I, Rose S. Relevance of CT-scans for pediatric head injuries. Unfallchirurg 2003;106:220–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. Am J Roentgenol 2001;176:289–96.Google Scholar
  25. 25.
    Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimates of the cancer risks from pediatric CT radiation are not merely theoretical: comment on “point/counterpoint: in X-ray computed tomography, technique factors should be selected appropriate to patient size against the proposition”. Med Phys 2001;28:2387–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Levin HS, Williams DH, Eisenberg HM, High WM Jr, Guinto FC Jr. Serial MRI and neurobehavioural findings after mild to moderate closed head injury. J Neurol Neurosurg Psychiatry 1992;55:255–62.CrossRefPubMedGoogle Scholar
  27. 27.
    van der Naalt J, Hew JM, van Zomeren AH, Sluiter WJ, Minderhoud JM. Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome. Ann Neurol 1999;46:70–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Yokota H, Kurokawa A, Otsuka T, Kobayashi S, Nakazawa S. Significance of magnetic resonance imaging in acute head injury. J Trauma 1991;31:351–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Homer CJ, Kleinman L. Technical report: minor head injury in children. Pediatrics 1999;104:e78.CrossRefPubMedGoogle Scholar
  30. 30.
    Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009;374:1160–70.CrossRefPubMedGoogle Scholar
  31. 31.
    Zimmer DB, Cornwall EH, Landar A, Song W. The S100 protein family: history, function, and expression. Brain Res Bull 1995;37:417–29.CrossRefPubMedGoogle Scholar
  32. 32.
    Lamers KJB, Vos P, Verbeek MM, Rosmalen F, Van Geel WJA, van Engelen BGM. Protein S-100B, neuron-specific enolase (NSE), myelin basic protein (MBP) and glial fibrillary acidic protein (GFAP) in cerebrospinal fluid (CSF) and blood of neurological patients. Brain Res Bull 2003;61:261–4.CrossRefPubMedGoogle Scholar
  33. 33.
    Petzold A, Keir G, Lim D, Smith M, Thompson EJ. Cerebrospinal fluid (CSF) and serum S100B: release and wash-out pattern. Brain Res Bull 2003;61:281–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Blomquist S, Johnsson P, Lührs C, Malmkvist G, Solem JO, Alling C, Ståhl E. The appearance of S-100 protein in serum during and immediately after cardiopulmonary bypass surgery: a possible marker for cerebral injury. J Cardiothorac Vasc Anesth 1997;11:699–703.CrossRefPubMedGoogle Scholar
  35. 35.
    Jönsson H, Johnsson P, Höglund P, Alling C, Blomquist S. Elimination of S100B and renal function after cardiac surgery. J Cardiothorac Vasc Anesth 2000;14:698–701.CrossRefPubMedGoogle Scholar
  36. 36.
    Usui A, Kato K, Abe T, Murase M, Tanaka M, Takeutchi E. S-100ao protein in blood and urine during open heart surgery. Clin Chem 1989;35:1942–4.PubMedGoogle Scholar
  37. 37.
    Anderson RE, Hansson LO, Nilsson O, Dijlai-Merzoug R, Settergren G. High serum S100B levels for trauma patients without head injuries. Neurosurgery 2001;48:1255–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Roche Diagnostics. Elecsys® S100 product information. USA: Roche Diagnostics Corporation, 2007:1–38.Google Scholar
  39. 39.
    Spinella PC, Dominguez T, Drott HR, Huh J, McCormick L, Rajendra A, Argon J, McIntosh T, Helfaer M. S-100beta proteinserum levels in healthy children and its association with outcome in pediatric traumatic brain injury. Crit Care Med 2003;31:939–45.CrossRefPubMedGoogle Scholar
  40. 40.
    Castellani C, Stojakovic T, Cichocki M, Scharnagl H, Erwa W, Gutmann A, Weinberg AM. Reference ranges for neuroprotein S-100B: from infants to adolescents. Clin Chem Lab Med 2008;46:1296–1299.CrossRefPubMedGoogle Scholar
  41. 41.
    Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H. GFAP versus S100B in serum after traumatic brain injury: relationship to brain damage and outcome. J Neurotrauma 2004;21:1553–61.CrossRefPubMedGoogle Scholar
  42. 42.
    Müller K, Townend W, Biasca N, Undén J, Waterloo K, Romner B, Ingebrigtsen T. S100B serum level predicts computed tomography findings after minor head injury. J Trauma 2007;62:1452–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Bloomfield SM, McKinney J, Smith L, Brisman J. Reliability of S100B in predicting severity of central nervous system injury. Neurocrit Care 2007;6:121–38.CrossRefPubMedGoogle Scholar
  44. 44.
    Poli-de-Figueiredo LF, Biberthaler P, Simao Filho C, Hauser C, Mutschler W, Jochum M. Measurement of S-100B for risk classification of victims sustaining minor head injury — first pilot study in Brazil. Clinics 2006;61:41–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Mussack T, Biberthaler P, Kanz KG, Heckl U, Gruber R, Linsenmaier U, Mutschler W, Jochum M. Immediate S-100B and neuron-specific enolase plasma measurements for rapid evaluation of primary brain damage in alcohol-intoxicated, minor head-injured patients. Shock 2002;18:395–400.CrossRefPubMedGoogle Scholar
  46. 46.
    Korfias S, Stranjalis G, Papadimitriou A, Psachoulia C, Daskalakis G, Antsaklis A, Sakas DE. Serum S-100B protein as a biochemical marker of brain injury: a review of current concepts. Curr Med Chem 2006;13:3719–31.CrossRefPubMedGoogle Scholar
  47. 47.
    Berger RP, Pierce MC, Wisniewski SR, Adelson PD, Clark RS, Ruppel RA, Kochanek PM. Neuron-specific enolase and S100B in cerebrospinal fluid after severe traumatic brain injury in infants and children. Pediatrics 2002;109:E31.CrossRefPubMedGoogle Scholar
  48. 48.
    Berger RP, Pierce MC, Wisniewski SR, Adelson PD, Kochanek PM. Serum S100B concentrations are increased after closed head injury in children: a preliminary study. J Neurotrauma 2002;19:1405–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Berger RP, Kochanek PM. Urinary S100B concentrations are increased after brain injury in children: A preliminary study. Pediatr Crit Care Med 2006;7:557–61.CrossRefPubMedGoogle Scholar
  50. 50.
    Berger RP, Dulani T, Adelson PD, Leventhal JM, Richichi R, Kochanek PM. Identification of inflicted traumatic brain injury in well-appearing infants using serum and cerebrospinal markers: a possible screening tool. Pediatrics 2006;117:325–32.CrossRefPubMedGoogle Scholar
  51. 51.
    Geyer C, Ulrich A, Gräfe G, Stach B, Till H. Diagnostic value of S100B and neuron-specific enolase in mild pediatric traumatic brain injury. J Neurosurg Pediatr 2009;4:339–44.CrossRefPubMedGoogle Scholar
  52. 52.
    Savola O, Pyhtinen J, Leino TK, Siitonen S, Niemelä O, Hillbom M. Effects of head and extracranial injuries on serum protein S100B levels in trauma patients. J Trauma 2004;56:1229–34.CrossRefPubMedGoogle Scholar
  53. 53.
    Ingebrigtsen T, Romner B. Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury. Case report. J Neurosurg 1996;85:945–8.CrossRefPubMedGoogle Scholar
  54. 54.
    Romner B, Ingebrigtsen T, Kongstad P, Børgesen SE. Traumatic brain damage: serum S-100 protein measurements related to neuroradiological findings. J Neurotrauma 2000;17:641–7.CrossRefPubMedGoogle Scholar

Copyright information

© Urban & Vogel München 2010

Authors and Affiliations

  • Annelie-Martina Weinberg
    • 1
  • Christoph Castellani
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Pediatric and Adolescent SurgeryMedical University GrazGrazAustria
  2. 2.Department of SurgeryDistrict Hospital VorauVorauAustria
  3. 3.Department of Pediatric and Adolescent SurgeryMedical University GrazGrazAustria

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