The relationship between cerebrospinal fluid creatine kinase and morphologic changes in the brain after transient cardiac arrest.

Abstract

SUMMARY Recent studies have shown that the increase in creatine kinase (CK) in lumbar spinal fluid (CSF) can effectively predict the outcome of cerebral ischemia after cardiac arrest. In the present investigation maximum CSF-CK concentrations in 40 patients who died more than 3 days after successful cardiopulmonary resuscitation were related to the histologic brain damage. Different regions of the brain show different sensitivity to anoxia.3 It is therefore conceivable that ischemic damage to small but functionally important areas of the brain may give only a small rise in CSF-CK. Further, variations in the speed of release of CK into the CSF and its appearance in the lumbar region might influence the reliability of the method as an indicator of brain damage. The present study was undertaken to correlate maximum levels of CK in the lumbar CSF with the degree of ischemic damage in the whole brain and in different brain regions at autopsy.

CSF enzymes in lacunar and cortical stroke.

“…[25][26][27] The previously observed unpredictability of appearance of enzymes in CSF may have been in part due to the presence of unrecognized lacunar syndromes and the degree to which infarction has been confined to the deep subcortex by brisk collateral blood flow. The finding of lack of elevation of CSF CK in patients with lacunar syndromes while a very slight elevation with LDH was seen is an intriguing one.…”

“…CK BB is most likely of neuronal and astrocytic origin 28 and quickly denatures at 37°C. 27 Presumably, in cases of lacunar infarction, all enzymes are released into the extracellular space but during the diffusion process, denaturation of CK has occurred before CSF spaces are reached. Alternatively, the lack of elevation of CSF CK could reflect a paucity of CK BB in the capsular region compared to cortical grey matter, a concept supported to some extent by recent studies.…”

Regional creatine kinase, adenylate kinase, and lactate dehydrogenase in normal canine brain.

“…Measurement of CK-BB activity in the CSF has been evaluated as a method to estimate the extent of brain damage and to predict prognosis following global brain injury. 5 " 8 The level of CK-BB in the CSF following transient cardiac arrest correlates well with the degree of brain damage found at autopsy. 3 More recently, CK-BB levels have been measured in CSF and serum following localized neurologic injury such as acute stroke.…”

The Prognostication of Cerebral Hypoxia after Out-of-Hospital Cardiac Arrest in Adults

“…As enzymes and other intracellular constituents of cerebral origin may be expected to appear in the cerebro spinal fluid (CSF) after ischemic injury of the brain [37,38], various investigations of CSF have been performed after CPR [35,36,[38][39][40][41][42][43][44], Edgren et al [20] demon strated the prognostic significance of CSF lactate and oth er biochemical parameters such as adenylate kinase activ ity which showed a good correlation between prediction and outcome at 24 h after CPR [20]. Karkela et al [35.…”