title: Biochemical analysis of the cerebrospinal fluid: evidence for catastrophic energy failure and oxidative damage preceding brain death in severe head injury: a case report.
abstract: OBJECTIVE
  To compare biochemical and clinical parameters in a case of fatal severe traumatic brain injury (TBI) with secondary insult.
  
  
  METHODS
  A TBI patient was catheterized for intracranial pressure (ICP) monitoring and cerebrospinal fluid (CSF) analysis of ascorbate, malondialdehyde, oxypurines, and nucleosides.
  
  
  RESULTS
  Oxidative brain damage preceded ATP catabolite increment in the CSF even with ICP below 20 mm Hg. Sustained oxidative stress caused irreversible energy state derangement followed by a refractory ICP rise. Massive oxypurine and nucleoside release was recorded 36 h before brain death.
  
  
  CONCLUSIONS
  Molecular events, detected by biochemical CSF analysis and preceding modification of clinical parameters in severe TBI with secondary insult, are discussed.
authors.affiliation: Department of Neurosurgery, University Hospital of Verona, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Cristofori
authors.forename: Barbara
authors.initials: B
authors.lastname: Tavazzi
authors.forename: Roberta
authors.initials: R
authors.lastname: Gambin
authors.forename: Roberto
authors.initials: R
authors.lastname: Vagnozzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Signoretti
authors.forename: Angela M
authors.initials: AM
authors.lastname: Amorini
authors.forename: Giovanna
authors.initials: G
authors.lastname: Fazzina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lazzarino
mesh_terms: D001205:Ascorbic Acid / Q000134:cerebrospinal fluid; D001926:Brain Death / Q000134:cerebrospinal fluid*; D001930:Brain Injuries / Q000134:cerebrospinal fluid*; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000134:cerebrospinal fluid; D008875:Middle Aged; D009705:Nucleosides / Q000134:cerebrospinal fluid; D018384:Oxidative Stress; D011687:Purines / Q000134:cerebrospinal fluid; D013997:Time Factors
chemical_list: D009705:Nucleosides; D011687:Purines; D008315:Malondialdehyde; D001205:Ascorbic Acid