gms | German Medical Science

Objective: The abundantly expressed vasoconstrictive Neuropeptide Y (NPY) has been shown to have the potential to significantly influence the development of vasospasm-related cerebral ischemia and functional outcome, subsequently after spontaneous subarachnoid hemorrhage (SAH). Here, we present the results of a prospectively designed observational study concerning the nuances of regulation of endogenous NPY in cerebrospinal fluid (CSF) and in serum according to location of aneurysm, modality of treatment and development of cerebral ischemia during the acute phase after SAH.

Method: Prospectively, we collected CSF and serum over ten days in 34 patients (18 female, 16 male) who received a ventricular drainage within 24 hours after onset of the SAH. All patients were graded 3 or 4 according to Fisher. The levels of NPY in serum and in CSF were determined using an enzyme-immunosorbent assay (EIA). The population was dichotomized due to aneurysmal location, treatment modality and development of vasospasm-related ischemia during the first 10 days.

Results:

1.

Patients with radiological assessable ischemia had significantly higher levels of NPY in CSF, p=0.037.

2.

The levels of NPY in CSF in anterior circulation aneurysms were significantly higher compared to those of the posterior circulation, p=0.021.

3.

A strong correlation between serum levels and CSF levels of NPY was detected in anterior circulation aneurysms, p=0.014.

4.

The levels of NPY in CSF ranged significantly higher in surgically or endovascularily approached aneurysms than in those without treatment, p=0.024.

Conclusions: The release of endogenous NPY is significantly correlated to cerebral ischemia. We found strong evidence that the anatomical location of the aneurysm and the manipulation of cerebral arteries potentially influenced the release of NPY into serum and CSF after SAH.