Protein S100b in differential diagnosis of brain concussion and superficial scalp injury in inebriated patients


Authors: J. Matek 1;  D. Vajtr 2;  Z. Krška 1;  D. Springer 3;  M. Filip 4;  T. Zima 3
Authors‘ workplace: 1. chirurgická klinika VFN 1. LF UK v Praze přednosta: Prof. MUDr. Z. Krška, CSc. 1;  Ústav soudního lékařství a toxikologie 1. LF UK a VFN v Praze, přednosta: Prof. MUDr. P. Strejc, DrSc. 2;  Ústav klinické biochemie a laboratorní diagnostiky 1. LF UK a VFN v Praze přednosta: Prof. MUDr. T. Zima, CSc. 3;  Oddělení neurochirurgie KNTB Zlín, primář: MUDr. M. Filip, PhD. 4
Published in: Rozhl. Chir., 2012, roč. 91, č. 10, s. 545-549.
Category: Original articles

Overview

Introduction:
Concussion cannot be differentiated from superficial scalp injury, especially in inebriated or uncooperative patients. This can have serious medical or forensic consequences. The aim of the study was to determine whether serum concentrations of S-100b in mild traumatic brain injury (MTBI) patients are significantly higher than those in patients with superficial scalp injury with scalp wound and alcohol intoxication.

Material and methods:
A total of 50 patients with head injury, 25 with mild concussion without scalp wound and alcohol intoxication, 25 superficial scalp injury patients with scalp wound and clinical signs of inebriety. Neurological status and cranial CT scan were evaluated 60–120 minutes after injury in all the 50 patients to exclude focal cerebral injury or skull fracture.

Results:
The serum levels of S-100b were significantly increased in patients with concussion (median 0.36 ± 0.15 μg/l ) in comparison with the group of patients with scalp injury and alcohol intoxication (median 0.09 ± 0.002 μg/l). All 50 patients had a normal cranial CT finding and neurological status. In all superficial scalp injury patients alcohol intoxication was confirmed (0.96 – 3.11š).

Conclusion:
We proved significantly higher values of S-100b in patients with brain concussion. Diagnostically decisive value of S-100b concentration in the serum was set at 146 μg/l and higher (94% sensitivity and 100% specificity). Alcohol intoxication (up to 3.11 š) and scalp wound seem to have had no crucial impact on serum S-100b level.

Key words:
concussion – S-100b – superficial scalp injury – alcohol intoxication.


Sources

1. Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain 1974;97(4):633-54.

2. Gennarelli TA. Cerebral concussion and diffuse brain injuries. In: Cooper PP, editor. Head injury. Williams and Wilkins, Baltimore 1982:83–97.

3. Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA et al. Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 1982;56(1):26–32.

4. De Kruijk JR, Leffers P, Menheere PPCA, Meerhoff S, Twijnstra A. S100-B and neuron-specific enolase in serum of mild traumatic brain injury patients. A comparison with healthy controls. Acta neurol Scandinavica 20001;103,(3):175–179.

5. Mussack T, Biberthaler P, Wiedemann E, Kanz KG, Englert A, Gippner-Steppert C, Jochum M. S-100b as a screening marker of the severity of minor head trauma (MHT)—a pilot study. Acta Neurochir Suppl 2000;76:393–6.

6. Unden J, Romner B. Can low serum levels of S100B predict normal CT findings after minor head injury in adults?: an evidence-based review and meta-analysis. J Head Trauma Rehabil 2010;25(4):228–40.

7. Unden J, Ingebrigtsen T, Romner B. Management of minor head injuries with the help of a blood test. S100B analysis can reduce the number of CT examinations and patient admissions. Lakartidningen 2008;105(24–25):1846–8.

8. Ingebrigtsen T, Sommer B, Marup-Jensen S, Dons M, Lundqvist C, Bellner J, Alling C, BŅrgesen SE. The clinical value of serum S100b protein measurements in minor head injury: a Scandinavian multicentre study. Brain Inj 2000;14(12):1047–1055.

9. Vajtr D, Průša R, Kukačka J, Houšťava L, Šámal F, Pelichovska M, Strejc P, Toupalík P. Evaluation of relevance in concussion and damage of health by monitoring of neuron specific enolase and S-100b protein]. Soud Lek 2007;52(3):43–6.

10. Townend W, Ingebrigtsen T. Head injury outcome prediction: a role for protein S-100B? Injury 2006;37(12):1098–108.Epub 2006.

11. Sawauchi S, Taya K, Murakami S, Ishi T, Ohtsuka T, Kato N, Kaku S, Tanaka T, Morooka S, Yuhki K, Urashima M, Abe T. Serum S-100B protein and neuron-specific enolase after traumatic brain injury. No Shinkei Geka 2005;33(11):1073–80.

12. Vajtr D, Průša R, Houšťava L, Šámal F, Kukačka J, Pachl J. Biochemical and immunohistochemical markers of brain injury. Soud Lek 2006;51(3):36–41.

13. Biberthaler P, Mussack T, Wiedemann E, Kanz KG, Gilg T, Gippner-Steppert C, Jochum M. Influence of alcohol exposure on S-100b serum levels. Acta Neurochir Suppl 2000;76:177–9.

14. Mittl RL, Grossman RI, Hiehle JF, Hurst RW, Kauder DR, Gennarelli TA, Alburger GW. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings, Am J Neuroradiol 1994;15(8):1583–9.

15. StĆlnacke BM, Björnstig U, Karlsson K, Sojka P. One-year follow-up of mild traumatic brain injury: post-concussion symptoms, disabilities and life satisfaction in relation to serum levels of S-100B and neurone-specific enolase in acute phase. J Rehabil Med 2005;37(5):300–5.

16. Bazarian JJ, Zemlan FP, Mookerjee S, Stigbrand T. Serum S-100B and cleaved-tau are poor predictors of long-term outcome after mild traumatic brain injury. Brain Inj 2006;20(7):759–65.

17. Kleinert K, Schleich F, Biasca N, Simmen HP. Zentralbl Chir 2010;135(3):277–8. Epub 2009.

18. Topolovec-Vranic J, Pollmann-Mudryj MA, Ouchterlony D, Klein D, Spence J, Romaschin A, Rhind S, Tien HC, Baker AJ. The value of serum biomarkers in prediction models of outcome after mild traumatic brain injury. J Trauma 2011;71(5 Suppl1):S478–86.

19. Savola O, Hillbom M. Early predictors of post-concussion symptoms in patients with mild head injury. Eur J Neurol 2003;10(2):175–81.

20. Waterloo K, Ingebrigtsen T, Romner B. Neuropsychological function in patients with increased serum levels of protein S-100 after minor head injury. Acta Neurochir (Wien) 1997;139(1):26–31.

21. Begaz T, Kyriacou DN, Segal J, Bazarian JJ. Serum biochemical markers for post-concussion syndrome in patients with mild traumatic brain injury. J Neurotrauma 2006;23(8):1201–10.

22. Woertgen C, Rothoerl RD, Brawanski A. Time profile of neuron specific enolase serum levels after experimental brain injury in rat. Acta Neurochir Suppl 2000;76:371–373.

23. Vajtr D, Filip M, Benada O, Linzer P, Šámal F, Springer D et al. Immunohistochemistry And Serum Values Of S-100B, Glial Fibrillary Acidic Protein, And Hyperphosphorylated Neurofilaments In Brain Injuries, Soud Lék 2012;57(1):7–12.

24. Bazarian JJ, Beck C, Blyth B, von Ahsen N, Hasselblatt M. Impact of creatine kinase correction on the predictive value of S-100B after mild traumatic brain injury. Restor Neurol Neurosci 2006;24(3):163–72.

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