Significance of serum neuron-specific enolase in patients with acute traumatic brain injury

OBJECTIVE: To study the association between serum neuron-specific enolase (NSE) and the extent of brain damage and the outcome after acute traumatic brain injury (TBI). METHODS: The release patterns of serum NSE in 78 patients after acute TBI were analyzed by using the enzyme linked immunosorbent assay. The levels of NSE were compared with Glasgow coma scale, the category of brain injury and the outcome after 6 months of injury. RESULTS: There were different NSE values in patients with minor (12.96 microg/L+/-2.39 microg/L), moderate (23.44 microg/L+/-5.33 microg/L) and severe brain injury (42.68 microg/L+/-4.57 microg/L). After severe TBI, the concentration of NSE in patients with epidural hematomas was 13.38 microg/L+/-4.01 microg/L, 24.03 microg/L+/-2.85 microg/L in brain contusion without surgical intervention group, 55.20 microg/L+/-6.35 microg/L in brain contusion with surgical intervention group, and 83.85 microg/L+/-15.82 microg/L in diffuse brain swelling group. There were close correlations between NSE values and Glasgow coma scale (r=-0.608, P<0.01) and the extent of brain injury (r=0.75, P<0.01). Patients with poor outcome had significantly higher initial and peak NSE values than those with good outcome (66.40 microg/L+/-9.46 microg/L, 94.24 microg/L+/-13.75 microg/L vs 32.16 microg/L+/-4.21 microg/L, 34.08 microg/L+/-4.40 microg/L, P<0.01, respectively). Initial NSE values were negatively related to the outcome (r=-0.501, P<0.01). Most patients with poor outcomes had persisting or secondary elevated NSE values. CONCLUSIONS: Serum NSE is one of the valuable neurobiochemical markers for assessment of the severity of brain injury and outcome prediction.     

老年急性颅脑外伤的血清甲状腺素变化及其临床意义

47例老年急性颅脑外伤患行血清T3、FT3均值明显低于正常对照组；T4、FT4，TSH则明显高于正常对照组。各项指标改变与脑损伤严重程度和病情变化有关。提示：甲状腺素测定有助于老年人急性颅脑外伤下丘脑—垂体—甲状腺轴调节在应激状态下功能的研究及预后判断。     

外伤性大脑镰旁血肿的诊断和治疗分析

目的探讨外伤性大脑镰旁血肿的发生机制、临床表现和治疗原则。方法回顾分析1995年以来收治的19例外伤性大脑镰旁血肿患者临床特点和治疗情况。结果治愈18例，1例因多脏器功能衰竭死亡。外伤性大脑镰旁血肿患者早期意识障碍不严重，其典型表现为对侧下肢单瘫或对侧偏瘫，下肢重于上肢。称为大脑镰综合征。结论头颅CT显示大脑纵裂池增粗的高密度影≥1cm及pseudodelta征，可作为诊断的参考标准。治疗以神经功能障碍或病情稳定与否来选择保守或手术治疗。