Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury

Case report

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✓ The authors studied 24 patients with a Glasgow Coma Scale score of 14 or 15 and normal computerized tomography scans after minor head injury. The study protocol included obtaining serial measurements of S-100 protein in serum during the first 12 hours after injury and early magnetic resonance (MR) imaging. Four patients (17%) had detectable levels of S-100 protein in serum. The S-100 protein levels were highest immediately after trauma, declining hour by hour. In two patients, MR imaging revealed intracranial contusion. Levels of S-100 protein were not detectable in serum in one patient with MR-verified cerebral contusion, but the first measurements were made late, 6 hours after trauma. The highest serum level of S-100 protein (0.9 µg/L) was seen in a 73-year-old man 2 hours after injury. Magnetic resonance imaging revealed a contusion of the left cerebellar hemisphere, and the patient suffered permanent sequelae of impaired posture and dizziness.

Article Information

Address reprint requests to: Tor Ingebrigtsen, M.D., Department of Neurosurgery, University Hospital of Tromsø, N-9038 Tromsø, Norway.

© AANS, except where prohibited by US copyright law.

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    Graph depicting serial serum levels of S-100 protein (µg/L) in four patients with minor head injury during the first 12 hours after trauma. In Cases 4 and 5, the protein was detectable only at the first measurement. Asterisks = Case 2; plus symbol = Case 3; closed circle = Case 4; open circle = Case 5.

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    Case 2. Computerized tomography scans obtained 4 hours after a minor head injury in a 73-year-old man revealing a linear fracture of the left occipital bone (left), but no intracranial lesion (right).

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    Case 2. Left: Magnetic resonance T2-weighted image obtained 19 hours after the trauma demonstrating a 30 × 25 × 20 mm large contusion in the left cerebellar hemisphere. Right: Magnetic resonance T2-weighted image obtained at a follow-up examination 6 weeks after injury showing a small cortical defect at the site of the previous lesion.

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