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European Journal of Anaesthesiology: January 1998 - Volume 15 - Issue 1 - p 126-127


In a recent editorial Dr Gao and Dr Harris gave an excellent summary of the interesting subject 'Biochemical markers of cerebral damage' [1]. 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 [17] (ref. 45 in the editorial).

Table 1
Table 1:
Different conditions in which CSF-AK has been analysed


Department of Anaesthesia and Intensive Care, Central Hospital, Västerås, Sweden


1 Gao F, Harris DNF. Biochemical markers of cerebral damage [editorial]. Eur J Anaesthesiol 1997; 14: 113-117.
2Ronquist G, Terent A. Cerebrospinal fluid markers of disturbed brain cell metabolism. Prog Neurobiol 1982; 18: 167-180.
3Frithz G, Ronquist G, Hugosson R. Perspectives of adenylate kinase activity and glutathione concentration in cerebrospinal fluid of patients with ischemic and neoplastic brain lesions. Eur Neurol 1982; 21: 41-47.
4 Enlund M. Induced hypotensive anaesthesia and cerebral function. Evaluation by biochemical and neuropsychological analyses and by functional imaging with PET. Dissertation. Acta Universitatis Upsaliensis, 1997.
5 Ronquist G, Frithz G, Ericsson P, Hugosson R. Malignant brain tumours associated with adenylate kinase in cerebrospinal fluid. Lancet 1977;ii: 1284-1286.
    6 Alm PO, Frithz G, Ronquist G. Adenylate kinase activity in cerebrospinal fluid of schizofrenic and certain other psychiatric symptomatologies. Acta Psychiat Scand 1979; 59: 517-524.
    7 Stensland E, Sandberg S, Berge R, Aarli JA, Romslo I. Adenylate kinase in neurological diseases. Lancet 1979; ii: 792-793.
      8 Terent A, Ronquist G. Cerebrospinal fluid markers of disturbed brain cell metabolism in patients with stroke and global cerebral ischemia. Acta Neurol Scand 1980; 62: 327-335.
      9 Åberg T, Tydén H, Ronquist G, Åhlund P, Bergström K. Release of adenylate kinase into cerebrospinal fluid during open-heart surgery and its relation to postoperative intellectual function. Lancet 1982;i: 1139-1142.
      10 Ronquist G, Frithz G. Effect of cardiac glycosides on the release of adenylate kinase into cerebrospinal fluid of patients with cerebral arteriosclerosis. Eur Neurol 1982; 21: 318-323.
      11 Ronquist G, Callerud T, Niklasson F, Friman G. Studies of biochemical markers in cerebrospinal fluid in patients with meningoencephalitis. Infect Immun 1985; 48: 729-734.
      12 Edgren E, Hedstrand U, Nordin M, Rydin E, Ronquist G. Prediction of outcome after cardiac arrest. Crit Care Med 1987; 15: 820-825.
      13 Ronquist G, Frithz G. Reversible brain cell damage due to hypoglycemia in a patient with insulinoma. Acta Neurol Scand 1989; 79: 75-76.
      14 Vreca I, Derganc M, Grosek S. Adenylate kinase in the cerebrospinal fluid of hypoxic newborns. Clin Biochem 1989; 22: 135-139.
      15Enlund M, Ahlstedt B, Revenäs B, Krekmanov L, Ronquist G. Adverse effects on the brain in connection with isoflurane-induced hypotensive anaesthesia. Acta Anaesthesiol Scand 1989; 33: 413-415.
      16Enlund M, Mentell O, Edmark L, Ronquist G. Low frequency of adenylate kinase release into cerebrospinal fluid during balanced, normotensive anaesthesia and a non-orthognathic surgical procedure. J Int Med Res 1997; 25: 92-97.
      17 Sellman M, Ivert T, Ronquist G, Caesarini K, Persson L, Semb BKH. Central nervous system damage during cardiac surgery assessed by 3 different biochemical markers in cerebrospinal fluid. Scand J Thor Cardiovasc Surg 1992; 26: 39-45.
      © 1998 European Academy of Anaesthesiology