Inflammatory cytokines in subarachnoid haemorrhage: association with abnormal blood flow velocities in basal cerebral arteries

Abstract

Subarachnoidal release of inflammatory cytokines (interleukin (IL)-1 , IL-6, and tumour necrosis factor (TNF)-) was characterised in 35 patients with subarachnoid haemorrhage (SAH) and control subjects and compared with development of complicating haemodynamic abnormalities in basal cerebral arteries and clinical outcome. Serial analysis allowed the observation of a subacute response profile of these key mediators of inflammation in the subarachnoidal space. This compartmentalised inflammatory host response was closely associated in time and extent with development of increased blood flow velocities in the basal cerebral vessels as recorded by transcranial Doppler sonography. Moreover, intrathecal secretion of inflammatory cytokines was significantly increased in patients with poor clinical outcome. Together, these findings suggest a role of excessive compartmentalised inflammatory host response in pathogenesis of cerebrovascular complications after SAH. (J Neurol Neurosurg Psychiatry 2001;70:534-537) Keywords: subarachnoid haemorrhage; inflammatory cytokines; cerebral blood flow; vasospasm; cerebral ischaemia Subarachnoid haemorrhage (SAH) most commonly occurs when an aneurysm in a basal cerebral artery ruptures. Among patients who survive this event, the leading cause of death and disability is subsequent constriction of the large cerebral arteries causing delayed cerebral ischaemia, the "second stroke". 1 2 Monitoring of cerebral blood flow velocities (CBFVs) in the large pial arteries identifies patients with SAH with raised risk for ischaemic complications. [3][4][5][6] In SAH, it has been shown in multiple studies that CBFVs on transcranial Doppler sonography are inversely related to vessel diameters on angiography. [3][4][5][6] The noninvasive character of this technique enables serial investigations of developing haemodynamic abnormalities in an individual patient.Earlier studies described inflammatory changes in SAH-that is, subarachnoidal and perivascular leucocytic infiltrates in the subarachnoidal space 7-9 in relation to development of cerebral vasospasms. 8 9 Moreover, the proinflammatory cytokines interleukin (IL)-1 , IL-6, and tumour necrosis factor (TNF)-that orchestrate the cascade of inflammatory host response to infection and tissue damage 10 11 have been detected in the CSF of patients with SAH. [12][13][14][15][16] These earlier findings suggest an inflammatory pathogenesis of vasospasms in SAH. In this study, we tested the hypothesis that the extent and pattern of secretion of key mediators of inflammation IL-1 , IL-6, and TNFare associated with development of haemodynamic abnormalities in basal cerebral arteries and with clinical outcome. Patients and methods PATIENTS AND CONTROL SUBJECTSThirty five patients (21 women and 14 men), aged between 23 and 76 (median 56) years with SAH caused by aneurysmal rupture and presenting within 48 hours after onset of first symptoms were studied. Hunt and Hess scores to classify disease severity were 1 in 9%, 2 in 11%, 3 in 32%, 4 in 29%, and...

Systemic interleukin-6 concentrations in patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage

“…1, 4,6,7 Inflammatory response with cytokine release is associated with severity of illness, clinical outcome and occurrence of CVS in patients with aSAH. [8][9][10] Higher levels of interleukin (IL)-6 in the cerebro-spinal fluid (CSF) have been linked to the occurrence of CVS and worse outcome. [10][11][12][13] Further, the occurrence of systemic inflammatory response syndrome has been linked to the development of CVS and worse outcome in patients with aSAH.…”

Perspectivas en el tratamiento del vasospasmo cerebral inducido por hemorragia subaracnoidea

“…Otra técnica utilizada como rutina durante la cirugía de aneurismas cerebrales es la incisión o apertura de la lamina terminalis. Esta técnica descrita por Yaşargil en Zürich a comienzos de los años setenta se popularizó rápidamente al [16][17][18][19][20][21][22][23][24][25][26][27] Perspectivas en el tratamiento del vasospasmo cerebral inducido por hemorragia subaracnoidea demostrarse que tenía un efecto positivo sobre la incidencia de la hidrocefalia inducida por la HSA. Algunos autores han demostrado una reducción hasta del 80% si la técnica se realiza de rutina durante el ataque microquirúrgico del aneurisma 44,91 .…”

“…El NO se forma a partir de la arginina, en presencia de la NO-sintetasa (NOS), que es [16][17][18][19][20][21][22][23][24][25][26][27] Figura 1. Cambios de diámetro en la arteria basilar de la rata posterior a la inyección de sangre en la cisterna magna.…”

“…Desde la introducción de la angioplastia con balón por el ruso Zubkov en 1984 92 , ha habido un gran número de descripciones de series de pacientes tratados con esta técnica 14,34,55,81 . Todos los autores coinciden en [16][17][18][19][20][21][22][23][24][25][26][27] Tabla 2 Resultados del tratamiento angioplástico farmacológico del vasospasmo cerebral con papaverina intraarterial por vía endovascular.…”

“…En nuestra experiencia, la angioplastia farmacológica PPV produce un mejoramiento rápido de la oxigenación cerebral medida en términos de saturación de oxígeno en el bulbo de la vena yugular interna 15 . Aunque un análisis retrospectivo multicéntrico no mostró beneficios de esta [16][17][18][19][20][21][22][23][24][25][26][27] 59 , a nuestro modo de ver, la PPV intraluminal sigue siendo una herramienta importante en el tratamiento del VC siempre y cuando sea apoyada por una terapia triple H intensiva antes, durante y después del tratamiento 17 .…”