The diagnostic value of measuring creatine kinase BB activity in cerebrospinal fluid following acute head injury.

During a period of 2 months the activity of creatine kinase BB (CK-BB) was measured in the cerebrospinal fluid (CSF) from 93 consecutive patients admitted as emergencies to the Neurosurgical Department. Fourteen of the 15 patients with verified brain contusion showed an increased activity of CK-BB in the CSF whereas all patients with various other acute neurological disorders, such as epilepsy and acute headache, had a normal CK-BB activity. Two of 5 patients with subarachnoidal haemorrhage and 13 of 58 patients classified as concussion also showed an increased CK-BB activity. Spinal fluid pressure, number of red cells and activity of CK (total) were less useful than CK-BB in diagnosing acute brain damage. Even diagnostic ventricular puncture with a Fisher cannula, producing a tiny (diameter = 2.8 mm) brain lesion, gave rise to an increased CK-BB activity. CSF sampled repeatedly from 10 other patients with brain contusion showed CK-BB activities that suggest the optimum period for sampling to be between one and 15 hours after head injury. The results obtained suggest that CK-BB is a reliable indicator of brain damage following head injury.