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Cerebrospinal fluid enzymology: creatine kinase, lactate dehydrogenase activity and isozyme pattern as a brain damage

Insights

Investigating toxic-induced seizures in a child revealed elevated brain enzymes in cerebrospinal fluid (CSF). Creatine kinase (CK) and lactate dehydrogenase (LDH) levels in CSF indicated potential brain damage.

Area of Science:

  • Neurology
  • Biochemistry
  • Toxicology

Background:

  • Pediatric convulsive episodes of toxic origin require accurate diagnostic markers.
  • Enzyme activity analysis in cerebrospinal fluid (CSF) can serve as an indicator of neurological insult.

Observation:

  • A 4.5-year-old girl presented with toxic-induced convulsive episodes.
  • Blood serum and CSF were analyzed for lactate dehydrogenase (LDH) and creatine kinase (CK) activities.
  • Enzyme levels were re-evaluated 45 hours after initial testing.

Findings:

  • Elevated serum and CSF levels of both LDH and CK were detected.
  • Creatine kinase (CK) activity was significantly higher in CSF (680 I.U./1) compared to blood serum (160 I.U./1).
  • CK in CSF was predominantly the BB isoenzyme (96%), and LDH was mainly the H4 isoenzyme (63%).

Implications:

  • CSF enzymatic profiles, particularly CK-BB and LDH-H4, may serve as valuable biomarkers for assessing brain damage in pediatric toxicological emergencies.
  • Serial enzymatic analysis in CSF can provide dynamic insights into the progression or resolution of neurological injury.

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