Kathleen J. Clayson

Cerebrospinal fluid and Serum creatine kinase BB activity after out‐of‐hospital cardiac arrest

In patients resuscitated from out-of-hospital cardiac arrest, neurologic outcome was compared with creatine kinase isoen-zyme BB activity (CKBB) in cerebrospinal fluid (CSF) in 20 patients and in serum in 52 patients. CSF CKBB was 2 units Der liter or less in patients with complete neurologic recovery but was significantly elevated in patients without neurologic recovery (mean, 55 units per liter) or with incomplete neurologic recovery (mean, 7 units per liter). Serum CKBB was detected more than 6 hours after cardiac arrest in only 4% of patients with complete neurologic recovery but in all patients without neurologic recovery. These results demonstrate a relationship between CSF and serum CKBB and neurologic outcome after cardiac arrest.

Cerebrospinal fluid creatine kinase activity and neurologic recovery after cardiac arrest

We evaluated prospectively the relation between cerebrospinal fluid creatine kinase activity (CSF CK) and neurologic recovery after out-of-hospital cardiac arrest. Without knowledge of the enzyme results, we determined whether patients awoke, followed commands, or had comprehensible speech. CSF CK was significantly higher in never-awakening than in awakening patients. After cardiac arrest, elevation of CSF CK predicts poor neurologic recovery.

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

Following acute stroke, creatine kinase and other enzymes are released into the cerebrospinal fluid and blood from injured brain tissue. To determine whether regional differences in brain enzyme activity might exist and therefore affect the amount of enzyme released, we quantified the levels of creatine kinase, adenylate kinase, and lactate dehydrogenase in 12 regions of normal canine brain (n = 4). Adenylate kinase activity varied the least among regions (49 +/- 7 units/g), followed by lactate dehydrogenase activity (122 +/- 28 units/g). The pattern for both adenylate kinase and lactate dehydrogenase was higher activity in predominantly gray matter areas, lower activity in white matter, and intermediate activity in mixed regions. The distribution of creatine kinase brain isoenzyme and mitochondrial creatine kinase in canine brain was less predictable, showing wider variations among regions (isoenzyme, 462 +/- 116 units/g; mitochondrial, 42 +/- 20 units/g). Even cerebral gray matter demonstrated substantial regional variations in creatine kinase brain isoenzyme, ranging from 606 units/g in the parietal cortex to 329 units/g in the temporal cortex. We conclude that the content of creatine kinase brain isoenzyme varies more than twofold among areas of brain. This regional variation may be important in the interpretation of creatine kinase brain isoenzyme measurements in cerebrospinal fluid and serum used to assess neurologic injury following stroke.

CLINICAL ENZYMOLOGY IN THE EVALUATION OF HEART AND LIVER DISEASE

Publisher Summary This chapter presents a few experimental studies on clinical enzymology in the evaluation of heart and liver disease. It describes the importance of organ specificity in relation to the selection of enzyme tests and the diagnosis of myocardial infarction. In a study described in the chapter, it was observed that bromsulfalein retention and prothrombin time were more sensitive than any of the enzyme tests studied in detecting injury secondary to chronic congestive failure. The chapter also presents a longitudinal study of several serum constituents in a patient with infectious hepatitis. A patient with unexplained alkaline phosphatase activity may present a problem in differential diagnosis. The issue of sensitivity in the detection of increased biliary pressure was earlier investigated by Reichard, who measured enzyme activity in cholecystectomized patients following the ingestion of a fatty meal and the administration of morphine. The data indicated that the serum enzyme activity frequently increased and that OCT was more sensitive than GPT or GOT.