Serial protein S-100 measurements related to early magnetic resonance imaging after mild head injury

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Head Injury - Pathophysiology of Head Injury

the degree of cell damage in the central nervous system (CNS) and the concentration of this CNS specific protein. The aim of this study was to investigate the S-l00 levels in serum and CSF in patients with no previous history of neurological disorder. Methods: We collected serum and CSF from 75 males and 35 females undergoing various surgical procedures in spinal anesthesia. One mL of CSF was taken from the spinal needle immediately before the spinal anesthesia was periormed. Simultaneously, 5 ml of serum was taken from a venous cannula. The concentrations of S-100 protein in CSF and serum were analysed using a commercially available two-site IRMA kit (Sangtec Medical, Bromma, Sweden). Results: S-100 protein was not detectable in serum. S-100 protein concentrations in CSF showed age- and sex-dependency. There was a significant difference between males and females, 1.9 ± 0.7 IJ- gIL vs 1.5 ± 0.5 IJ-glL, P 0.0026 (two tailed student t-test), Levels of S-100 protein in CSF increased with age but this increase was less pronounced in females (simple regression analysis). The median values and reference limits as percentiles in three age groups in males and females were estimated. Conclusions: This study underlines the necessity to use age- and sexmatched reference values when S-l 00 protein levels in CSF are to be evaluated in patients with different neurological disorders.

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I P-2-154I Cognitive function in patients with increased serum levels of protein S-100 after minor head injury K. Waterloo 1, T. Ingebrigtsen 2, B. Romner 3. ' Department of Neurology, University Hospitalof Iromso, Norway, 2 Department of Neurosurgery, University Hospitalof Itomso, Norway, 3 Department of Neurosugery, University Hospitalof Lund, Sweden Introduction: This report introduces protein S-l00, 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). This study investigates if high levels indicate cognitive dysfunction. Methods: A battery of conventional and computerized neuropsychological measures was administered to two groups of MHI patients. The neuropsychological tests administered were 4 subtests from the Halstead-Reitan test battery, 2 subtests from Wechsler memory scale-revised (WMS-R), Wisconsin card sorting test (WCST) and California computerized assessment package (CaICAP). Beck Depression Inventory (BDI) was used to evaluate posttraumatic depression as an alternative explanation for subtle cognitive abnormalities. Neuropsychological outcome at 12 months postinjury was examined in groups of 7 patients with increased serum levels of protein S-100 after MHI and 7 ageand sex-matched controls without detectable S-100 in serum after MHI. Data analysis included the unpaired Student's t-test to evaluate differences between group means. All p-values are two-tailed. Results: Our results demonstrate no overall cognitive dysfunction in any of the two groups. Our findings indicate specific dysfunction on measures of reaction time, attention and speed of information processing for the 5-1 00 group. Posttraumatic depression does not explain the neuropsychological differences between the groups. Conclusion: These findings support that increased serum level 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.

I P-2-155I serial protein S-100 measurements related to early magnetic resonance imaging after mild head injury T. Ingebrigtsen 1, 8. Romner 2. 1 Department of Neurosurgery, University Hospitalof tromee, Norway, 2 Department of Neurosurgery, University Hospital of Lund, Sweden Introduction: We recently introduced serum measurements of protein S-100 after mild head injury (MHI) and correlated detectable serum levels with an increased incidence of postconcussion symptoms and neuropsychological dysfunction. The present study describes serial protein S-100 measurements, and correlates these with magnetic resonance imaging (MRI). Methods: Twenty-four patients with MHI (history of head injury with loss of consciousness, GCS 14-15 and normal CT scan) were studied. We measured protein 5-100 in serum every hour after admission during the first 12 h postinjury. The detection limit of the protein S-l00 analysis kit (Sangtec Medical, Sweden) was 0.2 IJ-glL. MRI was periormed within 48 h after injury. Results: In 4 (17%) patients, S-100 protein was detected in serum (mean peak S-100 0.5 IJ-glL, range 0.2-0.9). The serum levels were decreasing hour-by-hour in all patients. MRI revealed intracranial contusion in two: In case, 1 5-100 was not detected, probably because the first blood sample was drawn

Monday, 7 July 1997 too late, 6 h after trauma. In case 2, MRI showed a cerebellar contusion. The highest protein S-100 serum level (0.9 IJ-glL) was detected in this patient 2 h after injury. He suffered persistent neurological sequelae. Conclusion: Serum levels of protein S-100 are highest during the first few hours after MHI. MRI may verify intracranial contusion in patients with high serum levels and normal CT scan.

I P-2-156I CSF hypersecretion as a cause of intracranial hypertension after head injury R. Vilcinis, E. Gruzas, L. Klumbys, Y. Sidiskis. KaunasAcademical Hospital,

Lithuania Introduction: The aim of the study was to assess the influence of CSF circulation disturbances after head injury on intracranial hypertension. Methods: The CSF dynamics were assessed by lumbar infusion-drainage method (Portnoy H.D. et at, 1976; Katzman R. et ai, 1970) and bolus technique (A. Marmarou et ai, 1975, 1978). The parameters were compared in 2 groups of head injured patients with subarachnoid haemorrhage: 36 patients with CSF hypertension (>15 torr) and 82 patients with CSF normotension «15 torr). Results: The elevation of CSF pressure among the patients with traumatic subarachnoid haemorrhage and abnormal CSF Outflow Resistance was associated with higher Rate of CSF Secretion in comparison with normotensive patients - 0.85 ± 0.42 (± S.D.) and 0.42 ± 0.25 mVmin (p < 0.001), according to drainage method and 0.8 ± 0.41 and 0.49 ± 0.26 ml/min (p < 0.05), according to bolus technique. The venous sinus pressure in CSF hypertension group was increased too, but its influence was less, as percentile part of CSF dynamic parameters increased from 37.9 ± 21% in CSF normotension group to 49.2 ± 16% in CSF hypertension group (p < 0.005). CSF Outflow Resistance did not differ significantly in the mentioned groups, but it was increased in both groups -22.1 ± 26 (hypertension) and 17.4 ± 23 (normotension) torr/ml/min. The rate of CSF Secretion correlated with the maximal amount of proteins in CSF r = 0.25 ± 0.12 (p < 0.05), it influenced the amplitude of CSF pressure - r = 0.2 ± 0.09 (p < 0.05) and index of spatial compensation r = -0.23 ± 0.1 (p < 0.05). Conclusion: CSF hypersecretion had a significant influence on the appearance of moderate CSF hypertension in head injured patients with subarachnoid haemorrhage and CSF outflow disturbance.

IP-2-157I

Plasma clotting and fibrinolysis parameters in patients with spontaneous and posttraumatic SAH

Katarzyna Wencel, Anna Dyaczynska-Herman, Tadeusz Wencel. Department

of Anaesthesiology and Intensive Care, Department of Neurosurgery, Silesian University Schoolof Medicine, Katowice, Poland An injury of the brain, one of the richest sources of thromboplastin occurs during SAH. This may result in liberating the thromboplastin into the circulation through a damaged blood-brain barrier and may cause different changes in hemostasis. Objectives: to evaluate some parameters of blood coagulation and fibrynolysis in patients with spontaneous and posttraumatic SAH. Material and Methods: 31 patients with SAH entered this study. In 17 cases SAH was due to closed head injury and in remaining 14 the underlying cause was a ruptured of vessel malformation. The following parameters of hemostasis were assessed: prothrombin time, activated partial thromboplastin time, thrombin time, levels of factors I, V, VII, VIII, IX, X, euglobulin clot lysis time, FOP and FM. All these parameters were tested three times - on the 1st, 3rd, 7th day of treatment. Results: During the study the complex changes in clotting and fibrynolitic systems were observed in both group of patients. The results show the presence of these changes in 8 posttraumatic patients and in 6 with vascular malformations. We found a relationship between the results of these tests and the patients condition after SAH. On admission, patients with great changes in measured parameters were in poor condition. The course of the disease was also worse in those patients. Conclusion: Complex changes in hemostasis, which occur during SAH, depend on severity of central nervous system damage and can influence the course of the disease. Simple laboratory tests can be useful in anticipating the possible complications of the disease.

I P-2-158I A study and dynamic observation on excitatory amino acids in cerebrospinal fluid following acute brain injnry and brain edema in humans Zhang XingDing, Qiu MingDe, Zhang XingHu, Zhang JianSheng, Zhang Hong, Cheng DeJun, Ding Yongzhong, Kong Dulun. Department of Neurosurgery,

SecondAffiliatedHospital; Institute of Neurology; LanZhou MedicalCol/ege, LanZhou, GansuProvince, PR China Introduction: Evidence from microdialysis experiments shows that excitatory amino acids (EAA) in extracellular fluid increase significantly following brain