Summary
In head injured patients changes were found in the CSF levels of metabolites of the dopaminergic and the serotonergic neurotransmission (HVA and 5-HIAA). After the fifth, day following trauma a significant derease of the HVA levels in the lumbar CSF after probenecid treatment was found. The intensity of this decrease was found to be related to the severity of the trauma (period of unconsciousness), but not to the state of consciousness.
Also the probenecid-induced 5-HIAA levels in conscious patients were decreased after the fifth post-traumatic day. In unconscious patients, however, an increased turnover of serotonin was found to be also related to the period of unconsciousness, particularly in the period of 5–20 days after trauma. Between 21 and 60 days after trauma the 5-HIAA concentrations in unconscious patients decreased remarkably, but they were still significantly higher than in the conscious patients. It can be concluded that during unconsciousness serotonergic neurons have a high rate of turnover, but that both neurotransmitter systems are damaged by the direct or indirect consequences of the injury.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bowers, M. B., CSF homovanillic acid: effects of probenecid and α-methyltyrosine. Life Sci.9 (1970), 691–694.
Carlsson, C. A., von Essen, C., Löfgren, J., Factors affecting the clinical course of patients with severe head injuries. Part 2: significance of posttraumatic coma. J. Neurosurg.29 (1968), 248–251.
Curzon, G., Kantamaneni, B. D., Wind, J., Rojas-Bueno, A., Murray-Lyon, I. M., Williams, R., Plasma and brain tryptophan changes in experimental acute hepatic failure. J. Neurochem.21 (1973), 137–145.
Garelis, E., Young, S. N., Lal, S., Sourkes, T. L., Monoamine metabolites in lumbar CSF: The question of their origin in relation to clinical studies. Brain Res.79 (1974), 1–8.
Guldberg, H. C., Ashcroft, G. W., Crawford, T. B. B., Concentrations of 5-hydroxy-indoleacetic acid and homovanillic acid in the cerebrospinal fluid of the dog before and during treatment with probenecid. Life Sci.5 (1966), 1571–1575.
Heiskanen, O., Sipponen, P., Prognosis of severe brain injury. Acta neurol. scand.46 (1970), 343–348.
Jacobson, S. A., Protracted unconsciousness due to closed head injury. Neurology6 (1956), 281–287.
Johansson, B., Roos, B. E., 5-Hydroxyindoleacetic acid and homovanillic acid in cerebrospinal fluid of patients with neurological diseases. Europ. Neurol.11 (1974), 37–45.
Jouvet, M., The role of monoamines and acetylcholine-containing neurons in the regulation of the sleep-waking cycle. In: Reviews of Physiology, Vol. 64, p. 166. Berlin-Heidelberg-New York: Springer. 1972.
Knell, A. J., Davidson, A. R., Williams, R., Kantamaneni, B. D., Curzon, G., Dopamine and serotonin metabolism in hepatic encephalopathy. Brit. med. J.1 (1974), 549–551.
Korf, J., van Praag, H. M., Amine metabolism in the human brain: further evaluation of the probenecid test. Brain Res.35 (1971), 221–230.
Lakke, J. P. W. F., Korf, J., van Praag, H. M., Minderhoud, J. M., Schut, T., Clinical significance of probenecid test. Lancet1 (1973), 614–615.
Moir, A. T. B., Ashcroft, G. W., Crawford, T. B. B., Eccleston, D., Guldberg, H. C., Cerebral metabolites in cerebrospinal fluid as a biochemical approach to the brain. Brain93 (1970), 357–368.
Munro, H. N., Fernstrom, J. D., Wurtman, R. J., Insulin, plasma aminoacid imbalance and hepatic coma. Lancet1 (1975), 722–724.
Neff, N. H., Tozer, T. N., Brodie, B. B., Application of steadystate kinetics to studies of the transfer of 5-hydroxyindoleacetic acid from brain to plasma. J. Pharmacol. exp. Ther.158 (1967), 214–218.
Olsson, R., Roos, B. E., Concentrations of 5-hydroxyindoleacetic acid and homovanillic acid in the cerebrospinal fluid after treatment with probenecid in patients with Parkinson's disease. Nature279 (1968), 502–503.
Osterholm, J. L., Bell, E., Meyer, R., Pyenson, J., Experimental effects of free serotin on the brain and its relation to brain injury. J. Neurosurg.31 (1969), 408–421.
Sachs, E., Acetylcholine and serotonin in the spinal fluid. J. Neurosurg.14 (1957), 22–27.
Sampath, S. S., Neff, N. H., The elimination of 5-hydroxyindoleacetic acid from cerebrospinal fluid: characteristics of the acid transport system of the choroid plexus. J. Pharmacol. exp. Ther.188 (1974), 410–414.
Teasdale, G., Jennett, B., Assessment of coma and impaired consciousness. Lancet2 (1974), 81–84.
Van Praag, H. M., Korf, J., Schut, T., Cerebral monoamines and depression. An investigation with the probenecid technique. Arch. gen. Psychiat.28 (1973), 827–831.
Vecht, Ch. J., van Woerkom, Th. C. A. M., Teelken, A. W., Minderhoud, J. M., HVA and 5-HIAA CSF levels and the state of consciousness after head-injury. Arch. Neurol. (1975 a) in press.
— — — —, 5-Hydroxyindoleacetic acid (5-HIAA) CSF levels in consciousness and unconsciousness after head injury. Life Sci.16 (1975 b), 1179–1186.
Werdinius, B., Effect of probenecid on the levels of monoamine metabolites in the rat brain. Acta Pharmacol. toxicol.25 (1967), 18–23.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vecht, C.J., van Woerkom, T.C.A.M., Teelken, A.W. et al. On the nature of brain stem disorders in severe head injured patients. Acta neurochir 34, 11–21 (1976). https://doi.org/10.1007/BF01405859
Issue Date:
DOI: https://doi.org/10.1007/BF01405859