Glutamic oxalacetic transaminase, lactic dehydrogenase, and creatine phosphokinase content in cerebrospinal fluid

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THE presence of the enzymes glutamic oxalacetic transaminase (GOT), lactic dehydrogenase (LDH), and creatine phosphokinase (CPK) in human cerebrospinal fluid (CSF) has been investigated by several authors,1–11 in order to determine the changes that occur in various clinical conditions. Conflicting and often contradictory results have been reported,12 particularly in regard to chronic neurologic diseases.

It has been postulated that destruction of tissues rich in GOT, LDH, and CPK initiates the release of these enzymes. An increase in the amount of any of these enzymes in fluids bathing the tissues would therefore indicate damage of such tissues. As applied to the central nervous system (CNS) the assumption has been made that a disorder severe enough to cause structural damage would result in the liberation of detectable amounts of GOT, LDH,13 and CPK14 into the CSF. Since it has been demonstrated that these enzymes do not freely cross the blood-brain and blood-CSF barriers,16 the likelihood exists that abnormal amounts detected within the confines of the barrier would signify damage to the CNS.

Most investigators have agreed that there is significant increase in the enzyme content of the CSF in patients with acute disorders of the CNS such as cerebrovascular accident,17 trauma,18 and meningoencephalitis.19–23 However, there are divergent opinions in regard to the enzyme values in subacute and chronic, progressive diseases with a long natural history and, at times, an almost imperceptible onset. These are the diseases for which there are no reliable laboratory tests that confirm the diagnosis in an early phase . . .



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