Correlation of Computed Tomography Findings and Serum Brain Damage Markers Following Severe Head Injury

Summary  The objective of our study was to investigate the association between the initial levels of serum S-100B protein and neuron specific enolase and the severitiy of radiologically visible brain damage and outcome after severe head injury.  Admission computed tomography (CT) scans of forty-four patients with severe head injury were analysed. Initial levels of S-100B protein and neuron specific enolase were compared between the different outcome groups at 6 month, the different categories of the Marshall classification, the presence of traumatic subarachnoid haemorrhage, the type of haematoma and the volume of contusion.  Serum S-100B was significantly higher in patients with unfavourable outcome (1.1 μg/1 versus 0.3 μg/1, p<0.005, Mann-Whitney U test). In diffuse injury, unfavourable outcome significantly increased with higher Marshall grades (p<0.05). There was a significant correlation between the four grades of diffuse injury and initial serum S-100B protein (r=0.48, p<0.001). Patients with focal mass lesions and a favourable outcome after 6 month had significantly lower S-100B values than those who had an unfavourable outcome (0.51 μg/l versus 1.3 μg/1, p<0.05). A significant correlation was demonstrated between the volume of contusion visible on CT scans and serum S-100B (r=0.58, p<0.001).  In our study, initial serum S-100B protein was a powerful predictor of outcome even within the same category of radiologically visible brain damage. Serum S-100B protein may provide independent information about the severity of primary brain damage after head injury.