SIGNIFICANCE OF ELEVATED PANCREATIC-ENZYMES IN INTRACRANIAL BLEEDING

Hyperamylasemia of pancreatic origin has been noted in patients with s evere head injury without abdominal trauma or evidence of pancreatitis . Thirty-eight patients with intracranial bleeding of various types we re evaluated for elevated pancreatic amylase and lipase enzymes withou t associated pancreatitis. Twenty-five patients had elevated serum lip ase; 17 of 25 also had elevated amylase without pancreatitis. Most lip ase elevations occurred earlier than those of amylase. Six clinical va riables-mannitol, ceftriaxone, nimodipine, steroids, Glasgow Coma Scor e, and total parenteral and enteral hyperalimentation-were evaluated t o determine relationship to the enzyme elevations; A significant relat ionship exists between patients not treated with steroids and elevated lipase and amylase enzyme activities. Multivariate analysis revealed a significant interaction between lipase elevation and decreasing Glas gow Coma Score, indicative of increasing severity of intracranial blee ding. Proposed causes of enzyme elevations in intracranial bleeding in clude vagal stimulation, altered modulation of the central control of pancreatic enzyme release, and release of cholecystokinin from the bra in. Physician awareness of the association of intracranial bleeding wi th the elevation of amylase and lipase without pancreatitis can save t he patient needless cost and manipulation.