Concentration of enkephalins in cerebrospinal fluid of patients after severe head injury.

We studied head-injured patients treated at the Department of Neurosurgery, Silesian University School of Medicine, Katowice. The patients underwent lumbar puncture on days 1, 4 and 7 for diagnostic reasons. The levels of leu-enkephalin (LENK) and met-enkephalin (MENK) were examined in 4.5 ml of cerebrospinal fluid (CSF). The control group included patients with lumbar discopathy from whom CSF fluid was collected during myelography. Enkephalins were extracted by column chromatography and their levels were assayed radioimmunologically. The results indicate that enkephalins may play a certain role in the pathophysiological response of nervous tissue to traumatic injury. Constantly elevated MENK levels together with decreasing LENK levels in patients with a Glasgow coma scale score < or = 8 may be useful as a poor prognostic factor. It is also suggested that LENK and MENK play different pathophysiological roles.

[Evaluation of the efficiency of intracranial volume compensation before and after surgical treatment of intracranial hematoma]. / Ocena wydolnosci wewnatrzczaszkowej kompensacji objetosciowej u chorych przed i po operacji krwiaka wewnatrzczaszkowego.

On the ground of the clinical status and indicators of intracranial pressure instability and cerebral arterial reactivity the authors evaluated the efficiency of intracranial volume compensatory mechanisms in 21 patients before and after operations for epidural and subdural haematomas and spontaneous intracerebral haematomas. The epidural haematomas in a greater degree but less permanently exhausted the efficiency of the compensatory mechanisms than subdural haematomas and after their removal these mechanisms regained easier their efficiency than after removal of subdural haematomas. In cases of spontaneous intracerebral haematomas the efficiency of the compensatory mechanisms is only slightly decreased.

CSF choline levels in groups of patients with cranial trauma or extrapyramidal disorders.

Choline levels in lumbar cerebrospinal fluid (CSF) were measured in patients with craniocerebral trauma (N = 67), Parkinson's disease (N = 20), miscellaneous extrapyramidal disorders (N = 28) and Huntington's chorea (N = 5). No differences in CSF choline levels were observed between these diagnostic groups and a group of neurological controls (N = 22). However, CSF choline levels were found to increase with age.

Intracranial pressure in children and adolescents with severe head injuries.

Long-term ICP monitoring was carried out in 53 children and adolescents with severe head injuries. 36 of them exhibited bilateral decerebrate posturing and 13 bilateral pupil unresponsiveness. The highest ICP levels never exceeded 10 mmHg in 3 patients, ranged between 11 and 20 mmHg in 12 and between 21 and 50 in 16. Fifteen patients showed sustained intracranial hypertension over 50 mmHg. Six patients died from fulminating intracranial hypertension and 21 died later (average survival 10.1 days). Five patients remained severely disabled and 21 satisfactorily recovered. Seven patients with the highest degrees of intracranial hypertension survived, in all of them ICP reached its peak more than 72 hours after injury. Early hypertension exceeding 50 mmHg always proved fatal. Four patients with mild hypertension but with very high elastance on P/V tests died. Although children and adolescents may withstand higher degrees of intracranial hypertension than adults, outcome remains poor despite active therapy in ICU patients with deep stabilised coma.

Free and conjugated dopamine in human ventricular fluid.

Free dopamine and an acid hydrolyzable conjugate of dopamine were measured in human ventricular fluid specimens with a radioenzymatic assay and by high performance liquid chromatography (HPLC) with electrochemical detection. Only trace amounts of free norepinephrine and dopamine were detected in ventricular fluid from patients with movement disorders. When the ventricular fluid was hydrolyzed by heating in HClO4 by lyophilization in dilute HClO4, however, a substantial amount of free dopamine was released. Values for free plus conjugated dopamine in ventricular fluid from patients who had never taken L-DOPA ranged from 139 to 340 pg/ml when determined by HPLC and from 223 to 428 pg/ml when measured radioenzymatically. The correlation coefficient for values obtained by the two methods in the same sample of CSF was 0.94 (P less than 0.001). Patients who had been treated with L-DOPA had higher levels of conjugated dopamine in their ventricular CSF which correlated inversely with the time between the last dose of L-DOPA and withdrawal of the ventricular fluid. Additionally, one patient with acute cerebral trauma had elevated levels of free norepinephrine and both free and conjugated dopamine in his ventricular fluid. Conjugation may be an important inactivation pathway for released dopamine in man.

[CSF enzyme activities in patients with head injury--especially on GOT, GPT, LDH, and CPK (AUTHOR'S TRANSL)].

In our studies on patients with head injury, it was noted that there are some correlations between their clinical courses and the urinary excretion of creatine (cr), creatinine (Crn), 17-ketosteroid and 17-hydroxycorticosteroid. We observed the high urinary excretion of Cr in patients with severe head injury while almost negative in a mild case. We reported those facts in 1974. Also noted in patients with head injury is the relationship between the enzyme-activities (GOT, GPT, LDH and CPK) in the cerebrospinal fluid and their clinical courses. In this paper, we reported 34 cases of head injured patients (simple type: 2, concussion: 9, contusion: 8, acute intracranial hematoma: 7 and chronic intra-cranial hematoma: 8). The control values of CSF enzyme-activities were determined in these 14 cases (simple head injury, whip-lash injury and osteoma of the skull) as GOT less that 15, GPT less than 7, LDH less than 12 and CPK less than 8 units. In the moderate cases, a slight increase in activities of 4 enzymes in CSF were observed, while in severe or comatose cases, the enzyme-activities (especially LDH and CPK) were greater than in the controls. In the dead cases these values were five times as high as the normal case. In the patients recovering from a serious stage, these activities decreased to normal. High CSF enzyme-levels tend to indicate a poor prognosis and low levels a favorable progrosis. In the patients with a significant elevation of CSF enzymes, a high urinary excretion of Cr [normal range: 0-150 (ca. 50)mg/day] was often observed. There was no apparent correlation between the enzyme level in CSF and that in serum and the increase or decrease of these 4 enzymes are not always proprotionate with each other. As reported by Green (1958) and Lending (1961), cerebral cell necrosis and increased permeability of BLB, BBB or cerebral cell membrane can be related to the increase of enzymeactivities. With these observations, it can be considered that severe head injury gives influence on metabolic function in the hypothalamus and may cause in the levels of CSF enzymes and/or the urinary excretions of Cr, Crn and corticosteroids. And the examinations of enzyme activities in the patients with head injury may become a useful aid to make an outlook of their clinical coure and prognosis.

Spectrophotometry of cerebrospinal fluid in subacute and chronic subdural haematomas.

Spectrophotometric examinations were performed on cerebrospinal and subdural fluids in subacute (five patients) and chronic (20 patients) subdural haematomas, with special reference to the diagnostic aid of CSF spectrophotometry. Spectrophotometric xanthochromia of haemorrhagic origin was found in all CSFs examined, while definite visible xanthochromia was observed in only 28% and the CSF was judged as colourless in 52% of those cases. Characteristic bleeding patterns were found spectrophotometrically in all the 20 CSFs examined within 24 hours after lumbar puncture, haematoma patterns being detected in 90-95% of the cases. In many cases the electrophoretically separated protein fractions of CSF and subdural fluids were spectrophotometrically examined. In conclusion, CSF spectrophotometry is a simple, fast, and extremely sensitive method, which in our opinion should be used routinely in the diagnosis of suspected subdural haematomas, if lumbar puncture is not contraindicated.