Serum- and CSF-concentrations of brain specific proteins in hydrocephalus.
OBJECTIVE
Hydrocephalus is characterised by elevated intracranial pressure (ICP) and gives rise to brain damage. The aim of this study was to investigate the significance of brain specific proteins as markers in the evaluation of brain damage in hydrocephalus. Therefore we determined the levels of four brain specific proteins in cerebrospinal fluid (CSF) and serum of symptomatic hydrocephalic patients.


METHODS
During 41 CSF shunt-operations (both primarily placed shunts and shunt-revisions) CSF and blood samples were obtained and analysed for neuron-specific enolase (NSE), S-100b, glial fibrillary acidic protein (GFAP) and myelin basic protein (MBP). The results were compared with an age-matched control group. Patients with varying clinical symptoms, denoting different levels of increased intracranial pressure prior to surgery, were included in this study.


RESULTS
We observed significantly increased CSF-levels of S-100b and GFAP in the hydrocephalic patients, whereas NSE and MBP were markedly increased only in patients with very severe symptoms. Serum levels of all proteins were only minimally increased and did not correlate with CSF-levels. The slightly elevated levels of CSF-NSE in most of the patients suggest only subtle neuronal damage, which is not related to permanent neurological symptoms. The elevated levels of S-100b and GFAP are indicative of a reactive astrogliosis, which has also been demonstrated in histopathological studies. No demyelination seems to occur, according to the normal levels of MBP observed in this study.


CONCLUSIONS
Although CSF levels of brain specific proteins are elevated in hydrocephalic patients, indicating brain damage due to hydrocephalus, neither CSF- nor serum-concentrations of brain specific proteins seem to be valuable tools in the clinical evaluation of the severity of hydrocephalus.
Beems
T
T
Department of Neurosurgery, University Medical Centre Nijmegen, The Netherlands.
Simons
K S
KS
Van Geel
W J A
WJ
De Reus
H P M
HP
Vos
P E
PE
Verbeek
M M
MM
D000293:Adolescent; D001925:Brain Damage, Chronic / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000097:blood* / Q000134:cerebrospinal fluid*; D006801:Humans; D006849:Hydrocephalus / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000150:complications; D008297:Male; D004676:Myelin Basic Protein / Q000097:blood* / Q000134:cerebrospinal fluid*; D009414:Nerve Growth Factors; D010751:Phosphopyruvate Hydratase / Q000097:blood* / Q000134:cerebrospinal fluid*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood* / Q000134:cerebrospinal fluid*; D012720:Severity of Illness Index
D005904:Glial Fibrillary Acidic Protein; D004676:Myelin Basic Protein; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase