TCE

Emanuel, 72 anos, hipertenso, diabético,

sofreu queda de outro nível/altura (~3m).
Após a queda, permaneceu inconsciente por
alguns minutos, sem crises convulsivas.
Foi resgatado pelo SAMU, e chegou ao PA
com alteração de nível de consciência.
G
L
4 -> AO
5 -> RV
6 -> RM
O
W
ECG 11 (AO3 RV2 RM6)
FC 51bpm
FR 12rpm irreg
Tax 37°C
PA 170x95mmHg
Sonolento, hipoativo
Pupilas isofoto
Após 3h da admissão, paciente evolui
com piora do RNC e anisocoria.

ECG 7 (AO2 RV1 RM4)

É realizada intubação orotraqueal e

solicitada vaga de UTI.
Dois dias depois, paciente ainda sem melhora do
quadro neurológico, apresenta pico febril isolado
(38,7°C às 4h da madrugada).

Naquele mesmo dia, passou a apresentar

dessaturação sob os mesmos parâmetros
ventilatórios, mantendo SatO2 à oximetria entre 92
e 95%.
Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
Myelin basic protein, specific to the myelin sheet
of CNS myelin, can be released into serum by
brain damage or demyelinating diseases and
appears to be a promising marker of TBI.

Although CSF and serum levels in TBI patients have

demonstrated excellent specificity, sensitivity has
been limited.

Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
UCH-L1 was demonstrated to be a sensitive and
specific biomarker of TBI.

Furthermore, although limited by a small subject

population, in mild-TBI, group data suggest that
higher levels of UCH-L1 are potentially associated
with the presence of intracranial lesions that are
detectable on CT.

Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
A study has been conducted recently examining serum UCH-L1
levels from adults with severe TBI, and their relationship with severity
of injury and clinical outcome.

UCH-L1 peaked early after injury and levels in

serum were significantly increased in TBI
patients compared with uninjured controls.
UCH-L1 serum concentrations were associated with
severity of injury, CT scan findings and outcome.

Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
UCH-L1 was shown as the only
independent predictor of in-hospital
mortality (adjusted odds ratio: 2.74;
95% CI: 1.537–4.896), and also as a
strong predictor of death 6 months
postinjury.

Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
Increased serum GFAP levels have been reported
in patients suffering from severe head trauma.

Recently, other reports have confirmed that serum

GFAP is a specific marker of brain damage after
head trauma. GFAP has also been demonstrated
to be a potential useful biomarker to predict clinical
outcome. Ongoing studies in our research group have shown
that serum GFAP levels are significantly higher in patients who died
6 months postinjury than in those who are alive.

Blood-based diagnostics of traumatic brain injuries. Expert Rev. Mol. Diagn. 11(1), 65–78 (2011)
Laboratório na prática clínica : consulta rápida [recurso eletrônico] / Organizadores, Ricardo M. Xavier, José Miguel Dora,
Elvino Barros. – 3. ed. – Porto Alegre : Artmed, 2016 - Capítulo 10.
Laboratório na prática clínica : consulta rápida [recurso eletrônico] / Organizadores, Ricardo M. Xavier, José Miguel Dora,
Elvino Barros. – 3. ed. – Porto Alegre : Artmed, 2016 - Capítulo 10.
Under normal homeostasis, pre-procalcitonin
undergoes initial synthesis by thyroid C cells.
Later this peptide is transformed into
procalcitonin via cleavage of a 25-amino acid
signal sequence by endopeptidases. The end
product calcitonin, the 32-amino acid hormone
responsible for serum calcium regulation, is
formed following conversion by the enzyme
prohormone convertase.
Cleland DA, Eranki AP. Procalcitonin. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539794/
Typically, physiological conditions result in
very low serum PCT levels of less than
0.05 ng/mL.
However, the synthesis of PCT can be
increased up to 100 to 1000 fold due to
circulating endotoxins or cytokines such as
interleukin (IL)- 6, tumor necrosis factor (TNF)-
alpha, and IL-1b, which act on various tissues.
Cleland DA, Eranki AP. Procalcitonin. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539794/
The extra-thyroid synthesis of PCT occurs in the
liver, pancreas, kidney, lung, intestine, and
leukocytes; notably, the synthesis of PCT is
suppressed within these tissues in the absence
of bacterial infection.
In contrast, cytokines released following viral
infection, such as interferon (INF)-gamma, will lead
to the down-regulation of PCT, thus highlighting
another advantage of PCT assays.
Cleland DA, Eranki AP. Procalcitonin. [Updated 2023 Apr 23]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539794/