In a recent editorial Dr Gao and Dr Harris gave an excellent summary of the interesting subject 'Biochemical markers of cerebral damage' . A number of markers were reviewed. However, it will not be without interest to add the enzyme adenylate kinase, AK, to the list of well validated markers of brain damage which can be measured in cerebrospinal fluid (CSF). AK has been used as a marker for many different pathological situations (Table 1), and CSF-AK analysis has been found to have high specificity and high sensitivity also. It is therefore implicit that the sample taken is handled properly and analysed according to certain standards [2-4]. A few controls have been presented, indicating that fit people or patients operated on for pulmonary lobectomy or hysterectomy have no or very low, CSF-AK activity, indicating no or minimal AK-leakage from unstressed brain cells [6,9,16]. When compared with neurone specific enolase, NSE, and S-100, it was found that AK and NSE were equal in indicating neuronal leakage, while S-100 represented leakage from glial cells  (ref. 45 in the editorial).
Department of Anaesthesia and Intensive Care, Central Hospital, Västerås, Sweden
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