gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Correlation of tumor necrosis factor-α, magnesium and calcium levels in cerebrospinal fluid with vasospasm-induced cerebral ischemia after subarachnoid hemorrhage (SAH)

Meeting Abstract

  • D. Podlesek - Klinik und Poliklinik für Neurochirugie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden
  • T. Juratli - Klinik und Poliklinik für Neurochirugie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden
  • K.H. Sitoci-Ficici - Klinik und Poliklinik für Neurochirugie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden
  • J. Kötteritzsch - Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden
  • S. Bergmann - Institut für Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden
  • G. Schackert - Klinik und Poliklinik für Neurochirugie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden
  • D. Krex - Klinik und Poliklinik für Neurochirugie, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.10.10

DOI: 10.3205/11dgnc174, URN: urn:nbn:de:0183-11dgnc1740

Published: April 28, 2011

© 2011 Podlesek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: The clinical course of patients with subarachnoid haemorrhage (SAH) due to a ruptured intracranial aneurysm is aggravated by the development of vasospasms and the occurrence of cerebral ischemic lesions. Inflammatory cytokines like TNF-α in the CSF of patients with subarachnoid haemorrhage are involved in the induction of the vasospasm cascade. Magnesium and calcium in the CSF are also known as potent vascular tone modulators. In the present study, we analyzed those parameters in the serum and CSF of patients with subarachnoid haemorrhage and different neurological outcomes. Results were compared with CSF data from patients with isolated intraventricular haemorrhage.

Methods: The CSF as well as serum-levels of TNF-α, calcium and magnesium were compared in 34 patients with SAH and in 6 patients with isolated intraventricular haemorrhage treated on intensive care unit. The population was divided into group A): patients with cerebral ischemia in more than 2 territorial areas of intracerebral arteries (severe vasospasm); group B): patients with less than 2 ischämic territories (moderate vasospasm); group C) patients without ischemic lesions (no vasospasm); and group D): patients with intraventricular haemorrhage (IVH). The median values of referred parameters in CSF and in blood samples were compared. In addition, those parameters were correlated with blood flow velocity values measured by transcranial Doppler.

Results: We observed increasing values of all three parameters in the CSF with increasing extent of vasospasm and infarction, respectively. IVH vs none vs moderate vs. severe vasospasm: Mg2+ 1,08, 1,06 1,11 1,195 mmol/l; Ca2+: 1,09 1,08 1,15 1,2 mmol/l; TNF-α 10,9 11,25 12,6 13,55 pg/ml. The highest measurable values of parameters were in the group with severe vasospasms and resulting cerebral ischemic lesions. Although 4 patients died in the first group with severe vasospasm, the TNF-serum level was highest in the IVH group: TNF-α-serum 17,5 vs 10,05 pg/ml in those with severe vasospasm. The increased values of the CSF parameters correlated with increasing median values of flow velocities.

Conclusions: We observed the highest CSF levels of magnesium and calcium and TNF-α in patients with severe vasospasms and resulting massive cerebral ischemia. Our data encourage to investigate a larger population in order to reach statistical significance and extract measurable predictors of vasospasm.