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Biochemical analysis of the cerebrospinal fluid: evidence for catastrophic energy failure and oxidative damage preceding brain death in severe head injury: a case report.

Cristofori L, Tavazzi B, Gambin R, Vagnozzi R, Signoretti S, Amorini AM, Fazzina G, Lazzarino G

Department of Neurosurgery, University Hospital of Verona, Italy.

OBJECTIVES: To compare biochemical and clinical parameters in a case of fatal severe traumatic brain injury (TBI) with secondary insult. DESIGN AND 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.

Published 20 December 2004 in Clin Biochem, 38(1): 97-100.
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