[On creatine kinase in the cerebrospinal fluid]

Assessment of cerebral injury with spinal fluid creatine kinase (CSF-CK) in patients after cardiac resuscitation

Serial determinations of creatine kinase in cerebrospinal fluid (CSF) were made in eighty-two patients, that were comatose after cardiac resuscitation because of ventricular fibrillation. In all patients who remained unconscious creatine kinase (CSF-CK) increased from less than 2 U/L to 11 U/L or more with maximum CSF-CK averaging 53 +/- 6 U/L 48-72h after resuscitation. In patients who recovered consciousness maximum CSF-CK activity never exceeded 11 U/L. However, maximum CSF-CK activity between 5 and 11 U/L was always associated with some permanent cerebral dysfunction. Complete cerebral restitution was only observed when maximum CSF-CK was 5 U/L or less. In some patients a maximum CK activity of 4 U/L was associated with depressed memory functions. The blood-brain barrier was impermeable to CK as evidenced by isoenzyme analysis and lack of correlation between CK activity in CSF and peripheral blood. CSF-pressure rose slightly to 217 +/- 11 mmH2O in patients with CSF-CK above 10 U/L and to 197 +/- 15 mmH2O when CSF-CK was below 5 U/L. The results indicate that high CSF-CK activity, whether appearing early or late after successful cardiac resuscitation, effectively predicts an unfavourable outcome of global cerebral ischemia. No rise in CSF-CK was always indicative of full cerebral recovery.

Brain-typical creatinekinase in the serum of newborn infants with perinatal brain damage

The normal values of serum-CK-activity in healthy newborns varied greatly (95% range: 4--165 U/l; 257 probands) and the borderline to pathological values was not sharp. Brain-typical CK-isoenzyme (CK-BB) could be detected in serum of 6 of 8 infants with perinatal brain damage by means of agar gel electrophoresis. The combination of neuropathological symptoms, increased total-serum-CK-activity, and significant amount of CK-BB in serum seemed to be a sure sign of severe CNS-damage in newborns.

Cerebrospinal fluid enzymes in acute brain injury. 1. Dynamics of changes in CSF enzyme activity after acute experimental brain injury

Changes in CSF enzyme activity were studied after brain trauma for their prognostic value. Raised values of CPK and HBDH were demonstrated in the CSF of patients with severe brain injuries. Standardised cold lesions of the brain were induced in cats. The activities of the enzymes CPK, HBDH, LDH, GOT, GPT, and pseudocholinesterase were studied at half hour intervals in the cerebrospinal fluid and at hourly intervals in the serum. A statistically highly significant increase of all enzymes studied developed in the CSF. The greatest changes occurred within four hours of freezing. Large increases could occur in half an hour. Isoenzyme studies demonstrated that CPK and LDH were of cerebral origin. No consistently significant changes could be shown in the serum enzyme activity. It is concluded that after brain injuries, enzymes are released into the extracellular fluid of the brain and transported to the CSF. The limited value of a single enzyme estimation is emphasised. The results described seem to provide indirect evidence for transependymal flow of extracellular fluid in brain oedema.