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An editorial on markers of cerebral damage


Author Information
European Journal of Anaesthesiology: January 1998 - Volume 15 - Issue 1 - p 125-126


Thank you for referring me to the letter from Dr Mats Enlund concerning the enzyme adenylate kinase (AK), a well validated marker of brain damage measured in cerebrospinal fluid(CSF).

We thank Dr Mats Enlund for his comments after reading our paper [1]. We agree that AK has been used as a marker of brain damage in a great number of different pathological situations. Brain tissue AK activities have been used to assess the degree of brain injury and the protective effects of hypothermia and antioxidant [2,3]. However, as Dr Enlund mentions in his letter, almost all publications available are from CSF-AK analysis. To our knowledge, there are no publications on plasma AK analysis. Ideally, for clinical purposes, it is necessary to have a biochemical marker that can be measured in blood.

Cerebrospinal fluid (CSF) concentration of adenylate kinase

Following cardiopulmonary bypass (CPB) surgery

A significant increase in CSF-AK was correlated with changes in an index of intellectual function [4] and psychometric performance [5]. Its measurement might therefore be useful in research to improve the quality of open-heart surgery. Magnetic resonance imaging (MRI) is a sensitive measure of subclinical cerebral ischaemia after CPB. CSF neurone-specific enolase (NSE) and lactic dehydrogenase may be less sensitive than MRI, but appear to be more sensitive than CSF-AK [6]. When CSF-AK was used to assess cerebral ischaemia of gaseous microembolic origin, there was no significant difference in AK as marker of ischaemia between nitrous oxide and control groups following CPB [7].

Following stroke and global cerebral ischaemia

CSF-AK levels were correlated with clinically neurological signs and sizes of infarction from computed tomography (CT) [8-10] following acute cerebral ischaemic infarction. However, the results were unrepeatable because of difficulties in sampling and handling CSF material [11]. The contamination of AK from erythrocytes and serum [12] is a significant limiting factor for AK to fulfil the criteria for an ideal CSF marker. Nevertheless, this limiting factor could be ruled out by using the specific light absorbency for oxyhaemoglobin [13].

Following cardiac arrest

The CSF-AK activity at 24 h after cardiac arrest showed predictive prognosis in 12 patients[14], however, CSF-AK did not show any prognostic value in neurological outcome after cardiac arrest in 32 patients in Edgren's study[15].

In summary, CSF-AK is an interesting and important biochemical marker of cerebral damage. However, serum AK levels may be difficult to interpret because of contamination by erythrocyte-derived AK.



Department of Anaesthesia and Intensive Care

Birmingham Heartlands Hospital; Birmingham, UK

Hammersmith Hospital; London, UK


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© 1998 European Academy of Anaesthesiology