CPK INCREASE AS AN OCCULT MARKER OF CEREBROVASCULAR DISEASE: A CASE REPORT

Creatine phosphokinase (CPK), an enzyme belonging to the wide family of kinases, is a protein essential for cells energy metabolism, especially to high energy consumption ones, for its ability to produces ATP, starting from creatine phosphate and ADP. Reaction reversibility allows rapid production, use and release of energy. Three different diagnostically significant isoenzymes have been identified: CPK-MM (predominant localization in muscle), CK-BB (predominant localization in brain; this one cannot be identified in systemic circulation unless of blood-brain barrier injury) and CPK-MB (myocardial localization; useful to early diagnosis of myocardial infarction). An increase in serum CPK occurs in several pathological conditions; differential diagnosis of a hyper-CPKemia can, therefore, be extremely complex and expansive. Medical history collection as complete as possible is crucial, especially in situations that may be hidden due to poor patient cooperation. Here we report the clinical case of a 65 years old non-smoker woman, who had an isolated creatine kinase and lactate dehydrogenase increase, due to several syncopal episodes with consequential ground drop, by pre-existing impaired cerebral blood flow.