gms | German Medical Science

Objective: Long-term neuropsychological dysfunction after the treatment for spontaneous subarachnoid hemorrhage (sSAH) is common but underreported. The abundantly expressed vasoconstrictory neuropeptide Y (NPY) has been shown to be released excessively after sSAH and in psychiatric disorders. We prospectively analyzed the treatment-specific differences in the secretion of endogenous cerebrospinal fluid (CSF)-NPY during the acute stage after sSAH and its impact on cognitive processing.

Methods: 26 consecutive patients (f:m=13:8; mean age 50.6 years) with good-grade sSAH were enrolled: n=9 received endovascular aneurysm occlusion (EV), n=6 were treated microsurgically (MS), and n=6 with perimesencephalic SAH underwent standardized intensive medical care. No patient experienced serious vasospasm-related ischemic or hemorrhagic complications. An external ventricular drain was inserted within 72 hours after the onset of bleeding. CSF was drawn daily from day 1 to day 10. The NPY levels were determined in duplicate CSF samples by means of competitive enzyme immunoassay (EIA). All patients were subjected to neuropsychological self-report assessment subacutely (day 11 – 35) after the onset of sSAH (t1) and at 6 month-follow-up (t2). Tests included the 36-Item Short Form Health Survey (SF-36) and the ICD-10-Symptom-Rating questionnaire (ISR).

Results:

1.

At t1, increased mean levels of NPY in CSF significantly correlated with a worse performance in most ISR scores (ISR total p=.018, depression p=.035, anxiety p=.008, nutrition disorder p=.047, supplementary items p=.038) and in several psychological SF-36 items (vitality p=.019, general mental health p=.001, mental component summary p=.025).

2.

Though all groups improved in various ISR and SF-36 scores over time, in the subacute phase, MS patients showed a better physical functioning (Pfi; p=.046), less bodily pain (Pain; p=.040) and less nutrition disorder (p=.009) than the EV group.

Conclusion: To the best of our knowledge, this study is the first to correlate the levels of endogenous NPY with cognitive outcome in good-grade sSAH patients. Excessive NPY release into CSF in the short-term might be involved in the pathogenesis of neuropsychological deficits. Our preliminary data suggests a better short-term Pfi, less Pain, and less nutrition disorder in surgically treated patients.