gms | German Medical Science

Objective: Our study investigates the relation of the mean quotient of ferritin in CSF and serum to ischemic brain infarction in SAH patients.

Methods: Prospective study including patients with aneurysmal SAH (modified Fisher Grade 4: 90% and modified Fisher Grade 2: 10%) and early aneurysm obliteration (first 72h) . The ferritin levels in the cerebrospinal fluid (CSF) and serum were measured daily over two weeks after hemorrhage (CSF/Serum ratio). Ischemic brain infarction was evaluated by computertomography 14 days after hemorrhage. Statistical significance between patients with and without infarction was calculated using the Mann-Whitney-U-test.

Results: So far 20 patients (7 male, 13 female) with a median age of 58 could be included. In 5/20 patients an ischemic brain infarction was observed. Initial serum and CSF ferritin concentrations were 252±284 ng/ml (mean±SD) and 109±70 ng/ml in patients with brain infarction and 195±162 ng/ml and 451±770 ng/ml in patients without brain infarction. During acute care the mean ferritin concentration in serum and CSF increased over time and reached a maximum plateau between day 8 to 11 with a mean serum concentration of 577±719 ng/ml and a mean CSF concentration of 2838±3518 ng/ml in patients with brain infarction and of 341±250 ng/ml and 18340±1632 ng/ml in patients without brain infarction. Furthermore, the ratio of mean serum and CSF concentration was significantly increased in patients with brain infarction (13.5) compared to patients without brain infarction (6.8, p<0.01).

Conclusion: The ferritin CSF/Serum ratio seems to be a predictive marker for the development of ischemic brain infarction after SAH. However, these results need further evaluation in a larger cohort.