This study aimed at the investigation of release patterns of neuron specific enolase (NSE) and protein S-100B after traumatic brain injury (TBI) and their association with intracranial pathologic changes as demonstrated in computerized tomography (CT). We analyzed NSE and S-100B concentrations in serial venous blood samples taken one to three days after TBI in 66 patients by the use of immunoluminometric assays. These markers are considered to be specific neurobiochemical indicators of damage to glial (S-100B) or neuronal (NSE) brain tissue. Standardized neurological examination and plani- and volumetric evaluation of computerized tomography scans were performed in all patients. Patients with medium severe to severe TBI [Glasgow Coma Scale (GCS) score at the site of accident < or =12] exhibited significantly higher NSE and S-100B concentrations and a significantly longer release compared to patients with minor head injury (GCS: 13-15). Both, patients with and without visible intracerebral pathology in CT scans exhibited elevated concentrations of NSE and S-100B after TBI and a significant decrease in the follow-up blood samples. Release patterns of S-100B and NSE differed in patients with primary cortical contusions, diffuse axonal injury (DAI), and signs of cerebral edema (ICP) without focal mass lesions. All serum concentrations of NSE and S-100B were significantly correlated with the volume of contusions. The data of the present study indicate that the early release patterns of NSE and S-100 may mirror different pathophysiological consequences of traumatic brain injury.

The data indicate that traumatic DAI results in mainly transient neuropsychological deficits. Focal frontal contusions result in more relevant deficits at outcome that affect behaviour and, thus, impair rehabilitation prognosis. It is concluded that even in clinically 'mild' TBI, prognosis and rehabilitation requirements should be established by early imaging and post-acute neuropsychological assessment.

Zusammenfassung: Auf der Basis einer retrospektiven Untersuchung von 175 Patienten, die im Laufe der letzten 4 Jahre mit der klinischen Verdachtsdiagnose einer Demenz in unserer Abteilung vorgestellt wurden, werden die neuropsychologischen Defizite verschiedener Patientengruppen mit Morbus Parkinson, Chorea Huntington (HD), Multisystematrophien, vaskulärer subcorticaler Encephalopathie, Normaldruck-Hydrocephalus und wahrscheinlicher Alzheimerscher Erkrankung (AD) verglichen. Die Ergebnisse zeigen bei allen Patientengruppen schwere Beeinträchtigungen in den Bereichen Aufmerksamkeit und exekutive Funktionen ohne signifikante Unterschiede zwischen den einzelnen Diagnosegruppen. Eine deutliche Clusterbildung in bezug auf stärkere Beeinträchtigungen zeigt sich hingegen bezüglich längerfristigen Gedächtnisleistungen (HD und AD) sowie bei aphasischen, sprachassoziierten und apraktischen Störungen (AD). Auf Basis dieser Befunde werden die möglichen Implikationen der neuropsychologischen Diagnostik für die Differentialdiagnostik der Demenz diskutiert.

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