Resuscitation. 4, 6 l-67
Enzymes in the cerebrospinal brain death C. VOISIN, F. WATTEL, Ph. SCHERPEREEL,
fluid in diagnosis of
B. GOSSELIN and C. CHOPIN
Centre de R&animation Refpiratoire, Hopital A. Calmette - 59000, Lille, France
Summary The increase of enzymes in the cerebrospinal fluid is shown to indicate an adverse prognosis, with the implication of irreversibility. The massive increase of glutamateoxaloacetate transaminase and lactate dehydrogenase and the appearance of alkaline phosphatases in a sample of cerebrospinal fluid in which the cytology is normal constitute an easy and reliable test for’brain death. The increase in lactate dehydrogenase fraction V and lysozyme in cerebrospinal fluid supports the macrophagic origin of these enzymes. Introduction Diagnosis of brain death is relatively easy when the clinical features are evident. Usual para-clinical tests are not reliable and early enough. Operations involving transplantations and cross-circulations make it necessary to foresee and to confirm cerebral death as soon as possible so that donors can be obtained in the best condition. Among the biochemical parameters considered in previous studies variations in activities of the enzymes in the cerebrospinal fluid appeared to be the most suitable criteria for cerebral death (Voisin, Wattel, Scherpereel, Gosselin, Chopin, Vallet & Dupas, 1972). Materials and method A sample of 90 comatose patients was divided into three groups: (i) 38 patients with reversible coma due to drug intoxication or encephalopathic states; (ii) 32 patients with long-term irreversible coma with conservation of vegetative functions; (iii) 20 patients with brain death. A correlative study was carried out of glutamate-oxaloacetate transaminase, lactate dehydrogenase and alkaline phosphatases in the blood and cerebrospinal fluid of these patients. These enzyme assays were done with a multi-sequential Auto-analyser (Technicon SMA 12/60). The analysis was performed on 2.6 ml of cerebrospinal fluid without prior concentration, but after checking for normal cytology. The lactate dehydrogenase isoenzymes were studied by electrophoresis of the blood and cerebrospinal fluid of 32 patients. The electrophoretic migrations were carried out on gelose and cellulose acetate, with Verona1 buffer of pH 8.6. After coloration by a tetrazolium salt, readings were made by densitometry. The lysozyme test was performed by the classical microbiological techniques using 61
62
C. VOISIN AND OTHERS
Table 1.
Enzyme activities in cerebrospinal fluid from patients in the three groups studied. Enzyme activity (i.u./l)
Condition
No. of patients
Alkaline phosphatase
Reversible coma Cerebral lesion Brain death
38 42 20
8 42
Lactate dehydrogenase 38 157 zdoo
Glutamateoxaloacetate transaminase 25 104 2250
Table 2. Lactate dehydrogenase isoenzyme V in cerebrospinal fluid from patients in the three groups studied. Mean values fSD are shown. Signiflcances of differences (P) indicated relate to the line above; P for reversible coma versus brain death was
Enzymes in the cerebrospinal brain death C. VOISIN, F. WATTEL, Ph. SCHERPEREEL,
fluid in diagnosis of
B. GOSSELIN and C. CHOPIN
Centre de R&animation Refpiratoire, Hopital A. Calmette - 59000, Lille, France
Summary The increase of enzymes in the cerebrospinal fluid is shown to indicate an adverse prognosis, with the implication of irreversibility. The massive increase of glutamateoxaloacetate transaminase and lactate dehydrogenase and the appearance of alkaline phosphatases in a sample of cerebrospinal fluid in which the cytology is normal constitute an easy and reliable test for’brain death. The increase in lactate dehydrogenase fraction V and lysozyme in cerebrospinal fluid supports the macrophagic origin of these enzymes. Introduction Diagnosis of brain death is relatively easy when the clinical features are evident. Usual para-clinical tests are not reliable and early enough. Operations involving transplantations and cross-circulations make it necessary to foresee and to confirm cerebral death as soon as possible so that donors can be obtained in the best condition. Among the biochemical parameters considered in previous studies variations in activities of the enzymes in the cerebrospinal fluid appeared to be the most suitable criteria for cerebral death (Voisin, Wattel, Scherpereel, Gosselin, Chopin, Vallet & Dupas, 1972). Materials and method A sample of 90 comatose patients was divided into three groups: (i) 38 patients with reversible coma due to drug intoxication or encephalopathic states; (ii) 32 patients with long-term irreversible coma with conservation of vegetative functions; (iii) 20 patients with brain death. A correlative study was carried out of glutamate-oxaloacetate transaminase, lactate dehydrogenase and alkaline phosphatases in the blood and cerebrospinal fluid of these patients. These enzyme assays were done with a multi-sequential Auto-analyser (Technicon SMA 12/60). The analysis was performed on 2.6 ml of cerebrospinal fluid without prior concentration, but after checking for normal cytology. The lactate dehydrogenase isoenzymes were studied by electrophoresis of the blood and cerebrospinal fluid of 32 patients. The electrophoretic migrations were carried out on gelose and cellulose acetate, with Verona1 buffer of pH 8.6. After coloration by a tetrazolium salt, readings were made by densitometry. The lysozyme test was performed by the classical microbiological techniques using 61
62
C. VOISIN AND OTHERS
Table 1.
Enzyme activities in cerebrospinal fluid from patients in the three groups studied. Enzyme activity (i.u./l)
Condition
No. of patients
Alkaline phosphatase
Reversible coma Cerebral lesion Brain death
38 42 20
8 42
Lactate dehydrogenase 38 157 zdoo
Glutamateoxaloacetate transaminase 25 104 2250
Table 2. Lactate dehydrogenase isoenzyme V in cerebrospinal fluid from patients in the three groups studied. Mean values fSD are shown. Signiflcances of differences (P) indicated relate to the line above; P for reversible coma versus brain death was
