Cerebrospinal fluid enzymes in acute brain injury

Severe brain injury is a major cause of death, especially in young men. In 1972, over 20% of all deaths occurring in England and Wales in men aged 15-25 years were due to head injury (Field, 1976). The mortality rate after severe brain injuries is higb. Jennett et al. (1977) reporting on a large international study comprising 700 patients describe a 53% mortality rate. In this study patients with brain injuries were studied in whom consciousness was suppressed for a period of at least six hours to a degree that inability to obey commands, to speak, or to open the eyes existed. Studies reported from different parts of Europe show a similar mortality rate (table 1 ). Not only do severe brain injuries call a large death toll, but many of the patients who survive remain disabled, often for life. Of 65 patients who were admitted to the University Hospital of Rotterdam in the period 1974-1976 with severe brain injury and were still alive after 6 months, 24 (37%) were disabled at that time. Disability may be due to physical sequelae, to disturbances of mental function, which are especially common following head injuries, or to difficulties arising when social reintegration is attempted.