Cerebrospinal fluid enzymes in acute brain injury. 2. Relation of CSF enzyme activity to extent of brain injury.

Maas, Andrew I. R.

doi:10.1136/jnnp.40.7.666

Cited by 23 publications

(4 citation statements)

References 12 publications

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“…Hypoxia causes release of CPK from damaged cells and increased CPK has been found in the cerebrospinal fluid in acute cerebral vascular accidents, encephalitis and head trauma, z2-z4 Cerebrospinal fluid CPK has several advantages as an index of brain damage, since it is principally derived from the central nervous system, does not normally cross the blood-brain barrier, 23 is not found in red blood cells which may contaminate cerebrospinal fluid samples, 24 and appears to be correlated with the severity of central nervous system damage. 22 Cerebrospinal fluid CPK increased to over three times the control during combined hyperventilation and hypotension, providing further evidence of cerebral hypoxia. The failure of cerebrospinal fluid lactate, lactate/pyruvate ratio, and CPK to fall until after hyperventilation was discontinued in group Ill animals suggests that the decreased cerebral oxygen supply resulting from combined hyperventilation and hypotension continues even after blood pressure returns to normal, as long as Paco2 remains near 3.33 kPa (25 mm Hg).…”

Section: Cerebrospinal Fluid Creatine Phosphokinasementioning

confidence: 79%

The combined effect of hyperventilation and hypotension on cerebral oxygenation in anaesthetized dogs

Levin

Zadigian

Hall

1980

Canad. Anaesth. Soc. J.

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This study was done to evaluate cerebral oxygenation in dogs under general anaesthesia with combined hypervenlilation and hypotension. Cerebral and muscle oxygen tensions, cerebrospinal fluid lactate, pyruvate, and creatine phosphokinase (CPK) were measured to test for cerebral hypoxia.Twenty dogs were anaesthetized with thiopentone 5 rag. kg -t and their tracheae were intubated. Anaesthesia was maintained with nitrous oxide and oxygen (50150), halothane 0.5 per cent, pancuronium 0. I mg. kg -~ per 1-2 hours and ventilation was controlled. Five dogs were maintained at normocapnia and normotension, five dogs were hyperventilated to Pa{,o~ 3.33 kPa (25 mm Hg) while blood pressure was kept at baseline levels (hyperventilation alone), and 10 dogs were hyperventilated to Paco~ 3.33 kPa (25 mm Hg) followed by deliberate hypotension to a mean arterial pressure of 6.65 kPa (50 mm Hg) with the use of nitroprusside and halothane (combined hyperventilation and hypotension).Cerebrospinal fluid lactate increased significantly from control during hyperventilation alone, with an even greater increase to above 4 mmol/I during combined hyperventilation and hypertension. The incremental rise of lactate with combined hyperventilation and hypolension was significant at the end of the second hour of hypotension. Cerebrospinal fluid lactatelpyruvate ratios and CPK increased significantly above control only with combined hyperventilation and hypotension.Oxygen tension of muscle and brain decreased from baseline with hyperventilation alone and decreased further to 2.66 kPa (20 mm Hg) after combined hyperventilation and hypotension. Good correlation was found between changes in oxygen tension of muscle and brain in the three groups (r -0.914, p < 0.05 and r -0.908, p < 0.05), respectively, for all groups combined.Evidence is thus presented that the combination of hyperventilation and hypotension to accepted levels causes inadequate cerebral oxygen supply in anaesthetized dogs. Although muscle and brain oxygen tensions reflected the degree of cerebral hypoxia, their usefulness as clinical monitors is likely to be limited. The work was done in the Department of Anesthesiology, Children's Memorial Hospital, Chicago. It was supported in part by a National Institute of Health Grant, number RR05475-15, and in part by the Northwestern University Department of Anesthesia.Presented at the annual meeting of the American Society of Anesthesiologists, Chicago, Illinois, October, 1978, and the annual meeting of the Anaesthesia Section, The American Academy of Paediatrics, Toronto, Ontario, April, 1979. Reprints requests to: Richard M. Levin, M.D., Department of Anaesthesia, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, Illinois, 60614 U.S.A.Canad. Anaesth. Soc. J., vol. 27, no. 3, May 1980 anaesthetic adjuncts combine cerebral vaso. constriction and decreased cerebral perfusion t( reduce brain size and produce a drier operativ~ field for more precise surgical dissection and re duced blood loss. t'2 Hyperventilati0n anc h...

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Section: Cerebrospinal Fluid Creatine Phosphokinasementioning

confidence: 79%

The combined effect of hyperventilation and hypotension on cerebral oxygenation in anaesthetized dogs

Levin

Zadigian

Hall

1980

Canad. Anaesth. Soc. J.

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“…The highest tissue CK-BB content was found in the brain cortex and capsula interna, whde only small amounts were measured in the pons, cerebellum and medulla oblongata (32). Therefore, a small focal lesion in a functionally important region of the brain may cause severe impairment with minimal enzyme release (15,33). On the other hand, the concentration of CK-BB in the CSF changes rapidly during the first hours of brain injury (19,29), thus the results depend on the time of collection of CSF.…”

Section: Discussionmentioning

confidence: 99%

Enzymatic changes in the cerebrospinal fluid in patients with infections of the central nervous system

et al. 1994

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Enzymatic determinations in cerebrospinal fluid (CSF) of aspartate aminotransferase (AST), lactic dehydrogenase (LDH), gammaglutamyl transpeptidase (GGT), creatine phosphokinase (CPK) and creatine kinase BB (CK‐BB) were performed in 16 patients with aseptic meningitis (AM), in 25 children with bacterial meningitis (BM) and in 15 patients with meningism. The activity of AST and GGT was significantly higher in patients with BM on admission compared with those with AM and meningism (p < 0.05 and p < 0.005, respectively) and decreased with therapy. The highest concentration of AST and LDH appeared in patients with poor outcome as well as in those with ventriculomegaly on neurosonography (p < 0.05). The concentration of CK‐BB increased in all patient groups on admission and remained higher on termination of therapy. The present study confirms the high activity of AST and GGT in BM patients in the CSF whereas the increased activity of AST and LDH reflects the extent of brain injury. Nevertheless, the prognosis for individual patients cannot be established on the basis of enzyme activity alone, but depends on several factors.□

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“…Along that line, it has previously been reported that cerebrospinal fluid (CSF) transaminases (SGOT, ALAT) were elevated in hypotensive anaesthesia (≤50 mmHg) 23,24 . In non‐human studies, Maas 25 reported that CSF enzymes were elevated in acute brain injury in rats. Also, the relationship between low blood pressure and tau protein is recognized in Alzheimer's Disease 26 …”

Section: Discussionmentioning

confidence: 87%

Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses

Larsen

Kobborg

Shahim

et al. 2020

Acta Anaesthesiol Scand

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Background Cerebral hypoxia may occur during surgery but currently used cerebral oxygenation saturation (rSO2) monitors remain controversial with respect to improving clinical outcome. Novel neuroprotein biomarkers are potentially released into systemic circulation and combined with near‐infrared spectroscopy (NIRS) could clarify the presence of per‐operative cerebral hypoxia. We investigated changes to serum‐neuroprotein concentrations post‐surgically, paired with NIRS and cognitive outcome, in patients operated in the beach chair position (BCP). Methods A prospective cohort in 28 shoulder surgery patients placed in the BCP. Blood samples were collected before induction of anaesthesia, and 2 hours and 3‐5 days post‐operatively. We analysed blood levels of biomarkers including tau and neurofilament light (NFL). We post hoc assessed the cross‐wise relationship between biomarker levels and post‐surgical changes in cognitive function and intraoperatively monitored rSO2 from NIRS. Results Serum‐NFL decreased from 24.2 pg/mL to 21.5 (P = .02) 2 hours post‐operatively, then increased to 27.7 pg/mL on day 3‐5 (P = .03). Conversely, s‐tau increased from 0.77 pg/mL to 0.98 (2 h), then decreased to 0.81 on day 3‐5 (P = .08). In 14/28 patients, episodic rSO2 below 55% occurred, and the duration < 55% was correlated to change in s‐tau (P < .05). The cognitive function z‐score at 1 week and 3 mo. correlated to the change in tau (P = .01), but not to NFL. Conclusion Some biomarkers were significantly changed with surgery in the beach chair position. The change was at some points associated to post‐operative cognitive decline, and to intraoperative low rSO2. (237).

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Cerebrospinal fluid enzymes in acute brain injury. 2. Relation of CSF enzyme activity to extent of brain injury.

Cited by 23 publications

References 12 publications

The combined effect of hyperventilation and hypotension on cerebral oxygenation in anaesthetized dogs

The combined effect of hyperventilation and hypotension on cerebral oxygenation in anaesthetized dogs

Enzymatic changes in the cerebrospinal fluid in patients with infections of the central nervous system

Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses

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