• W M Coplin, W T Longstreth, A M Lam, W L Chandler, T S Mayberg, J S Fine, and H R Winn.
• Department of Neurology, School of Medicine, University of Washington, Seattle, USA. wcoplin@med.wayne.edu
• Arch Neurol Chicago. 1999 Nov 1;56(11):1348-52.

BackgroundThe brain is rich in creatine kinase-BB isoenzyme activity (CK-BB), which is not normally present in cerebrospinal fluid (CSF). Results of previous studies have shown that CK-BB can be detected in the CSF of patients with aneurysmal subarachnoid hemorrhage (SAH), but whether CK-BB levels correlate with patients' neurologic outcomes is unknown.ObjectiveTo evaluate the relationship between CSF CK-BB level and outcome after SAH.DesignProspective observational cohort.SettingUniversity-affiliated tertiary care center.PatientsConvenience sample of 30 patients seen for cerebral aneurysm clipping.InterventionsWe sampled and assayed CSF for CK isoenzymes a median of 3 days after SAH in 27 patients, and at the time of unruptured aneurysm clipping in 3 patients.Main Outcome MeasuresWithout knowledge of CK results, we assigned the Glasgow Outcome Scale score early (approximately 1 week) and late (approximately 2 months) after surgery.ResultsHigher CSF CK-BB levels were associated with higher Hunt and Hess grades at hospital admission (Spearman rank correlation, p = 0.69; P<.001), lower Glasgow Coma Scale scores at hospital admission (p = -0.72; P<.001), and worse early outcomes on the Glasgow Outcome Scale (p = -0.64; P<.001). For patients with a favorable early outcome (Glasgow Outcome Scale score, 3-5), all CK-BB levels were less than 40 U/L. With a cutoff value of 40 U/L, CK-BB had a sensitivity of 70% and a specificity of 100% for predicting unfavorable early outcome (Glasgow Outcome Scale score, 1-2). Having a CK-BB level greater than 40 U/L increased the chance of an unfavorable early outcome, from 33% (previous probability) to 100%, whereas a CK-BB level of 40 U/L or less decreased it to 13%. Similar findings were obtained when considering late outcomes.ConclusionThe level of CSF CK-BB may help predict neurologic outcome after SAH.

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