TRANSCRANIAL CYTOKINE GRADIENTS IN PATIENTS REQUIRING INTENSIVE-CARE AFTER ACUTE BRAIN INJURY

After acute brain injury there may be increased intracranial productio n of cytokines, with activation of inflammatory cascades. We have soug ht to determine if a transcranial cytokine gradient was demonstrable i n paired sera of 32 patients requiring intensive care after acute brai n injury. The difference between concentrations of IL-1 beta, IL-6, IL -8 and TNF alpha in jugular venous and arterial serum was measured on admission, and at 24, 48 and 96 h after the primary injury. There were no differences in IL-1 beta, IL-8 or TNF alpha, but median gradients of 6.7 and 11.5 pg ml(-1) for IL-6 were demonstrated in the traumatic brain injury (n=22) and subarachnoid haemorrhage (n=10) groups, respec tively (normal values in serum <4.7 pg ml(-1); P<0.001 both groups). T his suggests that there is significant production of IL-6 by intracran ial cells after acute brain injury. Therapy directed towards combattin g the negative effects of IL-6 may potentially benefit patients who ha ve sustained an acute brain injury.