- Published: December 26, 2021
- Updated: December 26, 2021
- University / College: The University of Texas Southwestern Medical Center at Dallas
- Language: English
- Downloads: 2
A commentary on
Case report: extreme levels of serum S-100B in a patient with chronic subdural hematoma
by Persson M. E., Thelin E. P., and Bellander B. M. (2012) Front. Neurol. 3: 170. doi: 10. 3389/fneur. 2012. 00170
We are surprised by the conclusions of a recent paper by Persson et al. (2012), “ Case report: extreme levels of serum S-100B in a patient with chronic subdural hematoma,” which suggest that S-100B protein is an important marker for chronic subdural hematoma (CSDH). In our opinion, and that of other authors, S-100B is a significant marker of multiple neurological pathologies.
Chronic subdural hematoma is a relatively common complication, especially among the elderly, where the incidence is estimated as 7. 4/100, 000. Two circumstances account for its high incidence among the elderly; the extensive brain atrophy often found in the elderly or alcoholics, and long-term use anticoagulant ( Gelabert et al., 2001 ). CSDH in patients less than 50 years old is rare, and when it does occur it usually points to a predisposing factor, as in this case, where a brain metastasis led to the formation of a hematoma ( Gelabert-González et al., 2012 ).
Moreover, while the radiological image of the patient in their study shows a hematoma, it is of small and therefore leads one to question how this can be responsible for such a midline shift. This suggests that something more must be involved, as was revealed at autopsy where a metastases was identified.
In a recent paper, Kruijff and Hoekstra (2012) state that the protein S-100B is probably the best biomarker for melanoma, having potential to identify high-risk stage III melanoma patients who may benefit from adjuvant systematic treatment. Since an effective (adjuvant) therapy for loco-regional metastatic and disseminated melanoma has only been recently introduced, the diagnostic of S-100B, they argue, is set to increase in the near future.
It therefore appears inappropriate to consider differential levels of S-100B as indicative of the evolution of CSH, as suggested by the paper’s title, since they can be more indicative of a melanoma and its metastasis.
References
Gelabert, M., López, E., and Fernández, J. M. (2001). Chronic subdural hematoma treated by burr holes and closed drainage system: a review of 630 cases. Med. Principles Pract. 10, 41–47.
Gelabert-González, M., Frieiro-Dantas, C., Serramito-García, R., Díaz-Cabanas, L., Aran-Echabe, E., Rico-Cotelo, M., et al. (2012). Chronic subdural hematoma in young patients. Neurocirugia (Astur.) pii: S1130–S1473(12)00156-X. doi: 10. 1016/j. neucir. 2012. 08. 002
Kruijff, S., and Hoekstra, H. J. (2012). The current status of S-100B as a biomarker in melanoma. Eur. J. Surg. Oncol. 38, 281–285.
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
Persson, M. E., Thelin, E. P., and Bellander, B. M. (2012). Case report: extreme levels of serum S-100B in a patient with chronic subdural hematoma. Front. Neurol. 3: 170. doi: 10. 3389/fneur. 2012. 00170
Pubmed Abstract | Pubmed Full Text | CrossRef Full Text
