Useful markers to assess traumatic and hypoxic brain injury

V. I. Chirica,

Abstract: Traumatic Brain Injury, TBI, is a very important health issue world wide. Many traumatic events are not witnessed and not declared, especially in mild TBI, mTBI, and therefore not known, not treated or cured.
At autopsy the diagnosis of brain injury is in many cases a challenge especially in children with physical abuse. Quite often the judicial system ask for scientific proofs of objectivity in determining the cause of death in head trauma. Sometimes legal medicine is called to determine the extent of the brain injuries following anoxia or hypoxia after a CA resuscitated. Pathology and anatomic pathology sometimes may offer important clues for diagnosis but often there are time consuming.
The use of biomarkers in predictive way for prognosis and for diagnosis is a very potent and useful tool in legal medicine. Some of the brain injury biomarkers express the integrity of neurons or neurologic network, including astrocytes, and therefore express the structural integrity of the nervous system. The cutoff limit of these markers is in scientific debates and legal medicine may offer a support for their research. Some biomarkers are studied and presented such as biofluid biomarkers of astroglial injury, S100Beta, Glial Fibrillary acid protein (GFAP), biofluid biomarkers of neuronal injury, Neuron-specific enolase (NSE), Ubiquitin C-terminal hydrolase-L1 (UCH-L1), CK0BB, Brain-derived neurotrophic factor, BDNF, Biofluid biomarkers of axonal injury, Alpha-II spectrin, Tau protein, Neurofilaments, N-Cam or selectins.
Biomarkers could potentially facilitate diagnosis and risk stratification of mTBI and impact management of these patients as much as the diagnosis of TBI in legal medicine practice and in justice.
Keywords: traumatic brain injury, biomarkers, predictive value, diagnosis.