Outcome prediction in traumatic brain injury: comparison of neurological status, CT findings, and blood levels of S100B and GFAP.

OBJECTIVE: To investigate the predictive value of early serum levels of S100B and glial fibrillary acidic protein (GFAP) in traumatic brain injury. METHODS: Sixty patients admitted within 24 h of trauma were included. Neurological status on admission (Glasgow Coma Scale), initial cranial computed tomography (CCT) studies (Marshall Computed Tomographic Classification), and outcome after 6 months (Glasgow Outcome Scale) were evaluated. S100B and GFAP levels were determined on admission and 24 h after trauma. RESULTS: Blood levels of S100B and GFAP were elevated following head trauma and quantitatively reflected the severity of trauma. S100B levels after 24 h and on admission were of higher predictive value than CCT findings or clinical examination. GFAP, but not S100B levels rapidly declined after trauma. CONCLUSIONS: Blood levels of S100B and GFAP indicate the severity of brain damage and are correlated with neurological prognosis after trauma. Both methods can yield additional prognostic information if combined with clinical and CCT findings.

Frontal and lateral characteristics of the osseous configuration in chronic ankle instability.

OBJECTIVE: The osseous ankle configuration (tibiotalar sector, talar radius and height) has been discovered as intrinsic risk factor for chronic ankle instability (CAI). These measurements were done on lateral radiographs only. In this study, the osseous characteristics in the frontal plane and further lateral values were measured. DESIGN: Level III case-control study. SETTING: Radiological measurement of frontal and lateral radiographs by one independent, blinded radiologist using a digital DICOM/PACS system. PATIENTS: A group of 52 patients with CAI was compared with an age- and sex-matched control group of 52 healthy subjects. MAIN OUTCOME MEASUREMENTS: In the frontal plane, the depth of the talar curvature (frontal curvature (froCu)) and the lateral and medial malleolar lengths were measured. In the lateral plane, the position of the centre of rotation to the tibial axis (talar centre of rotation to the anatomical axis of the tibia (TibCOR)) and the tibial lateral surface angle (TLS) were also measured. RESULTS: The froCu was deeper in patients with CAI (1.8 (0.5) mm) than in healthy subjects (1.0 (0.5) mm, p<0.05). The TibCOR was more anterior in patients with CAI (2.5 (1.9) mm) than in healthy subjects (1.6 (2.2) mm, p<0.05). The distance from the fibular tip to the centre of rotation was smaller in patients with CAI (3.5 (3.4) mm) than in healthy subjects (6.5 (3.3) mm, p<0.05). The TLS and the length of the lateral and medial ankle were not significantly different. CONCLUSIONS: This study supports that the osseous joint configuration is an intrinsic risk factor for CAI. It could be shown that CAI is characterised by a deeper frontal curvature of the talus and a more anterior position of the talus to the tibia.

Klippel-Feil syndrome and Sprengel deformity combined with an intraspinal course of the left subclavian artery and a bovine aortic arch variant.

SUMMARY: We present a case of Klippel-Feil syndrome and Sprengel deformity with a bovine aortic arch and an aberrant course of the left subclavian artery in a 14-year-old boy. CT and MR imaging of the neck and upper thorax demonstrated a cervical osseous segmentation anomaly, a left common carotid artery originating from the innominate artery, and a left subclavian artery coursing through the intraspinal space at the C6 through T1 level. Possible embryonic mechanisms and clinical significance of this variant are reviewed.

Camel bite: an unusual type of head injury in an infant.

Small children are predisposed for animal bite wounds in the craniofacial region, because the likelihood of sustaining trunk and extremity injuries increases with height. The clinical picture of animal bite wounds is highly variable. Depending on the dental anatomy of the biting animal, such wounds may range from sharp stitch wounds to extensive lacerations with or without tissue loss. The ears and nose are injured most often because of their exposed location. Nevertheless, depressed skull fractures with injury to the dura and to the brain parenchyma are extremely rare. This case presentation describes the rare case of a craniocerebral camel bite wound (Lackmann stage IV B) in a 3-year-old girl that required immediate neurosurgical management. The neurosurgical management, choice of antibiotic, postoperative treatment, and clinical course are discussed, and background information on camel bite injuries is given.

Evaluation of CSF glial fibrillary acidic protein (GFAP) as a putative marker for HIV-associated dementia.

BACKGROUND: The involvement of the central nervous system (CNS) is a prominent feature of infection with human immunodeficiency virus type-1 (HIV-1). One of the neuropathological hallmarks of HIV-1-associated dementia (HAD) is the proliferation of astrocytes (astrogliosis). The major structural protein of astrocytes is glial fibrillary acidic protein (GFAP) and its increased expression has been reported in disorders characterized by astrogliosis. PATIENTS AND METHODS: In order to determine whether CSF GFAP may be a putative marker for HAD, we measured CSF GFAP levels of HIV-infected patients with (n = 11) and without (n = 21) HAD, and, additionally, of HIV-infected patients with opportunistic CNS diseases (n = 13) and HIV negative control patients (n = 20) using an immuno flourescent sandwich immunoassay. RESULTS: CSF GFAP levels and the frequency of increased GFAP levels did not significantly differ between the three groups of HIV-infected patients. CONCLUSION: Our data suggest that CSF GFAP is not a sensitive laboratory marker for HAD.