gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Excessive release of endogenous calcitonin gene-related peptide into cerebrospinal fluid after treatment of good-grade spontaneous subarachnoid haemorrhage – possible impact on short-term quality of life, anxiety, and depression

Die exzessive Freisetzung von endogenem Calcitonin gene-related peptide in den Liquor nach Therapie der spontanen Subarachnoidalblutung bei einem prognostisch günstigen Patientenkollektiv – Der potentielle Einfluss auf Lebensqualität, Angst und Depression in den ersten sechs Monaten nach Iktus

Meeting Abstract

  • presenting/speaker Elisabeth Bründl - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Martin Proescholdt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Eva-Maria Störr - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Petra Schödel - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Sylvia Bele - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Julius Höhne - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Florian Zeman - Universitätsklinikum Regensburg, Zentrum für Klinische Studien, Regensburg, Deutschland
  • Alexander Brawanski - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Karl-Michael Schebesch - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV279

doi: 10.3205/19dgnc298, urn:nbn:de:0183-19dgnc2989

Veröffentlicht: 8. Mai 2019

© 2019 Bründl et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Neuropsychological dysfunction after treatment of spontaneous subarachnoid hemorrhage (sSAH) is common but underreported. The vasodilatory calcitonin gene-related peptide (CGRP) is excessively released after sSAH and modulates psycho-behavioral function. We prospectively analyzed the treatment-specific differences in the secretion of endogenous cerebrospinal fluid (CSF) CGRP during the acute stage after good-grade sSAH and its impact on self-reported cognitive processing.

Methods: 26 consecutive patients (f:m=13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out n=5): n=9 underwent endovascular aneurysm occlusion, n=6 microsurgery, and n=6 patients with perimesencephalic SAH received standardized intensive medical care. No patient developed any 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 1–10. CGRP levels were determined in duplicate CSF samples with competitive enzyme immunoassay and calculated as “area under the curve” (AUC). All patients underwent neuropsychological self-report assessment [36-Item Short Form Health Survey (SF-36) and ICD-10-Symptom-Rating questionnaire (ISR)] after the onset of sSAH (t1: day 11–35) and at the 6-month follow-up (t2).

Results: At t1, increased mean levels of AUC CGRP in CSF significantly correlated with a higher symptom burden in most ISR scores (compulsive-obsessive syndrome p=.022, anxiety p=.035, depression p=.011, somatoform syndrome p=.013, supplementary items p=.015) and with impaired performance in 2 physical SF-36 items (general health perception p=.043, physical component summary p=.006). Regression analyses did not reveal any significant correlation between AUC CGRP levels and patient variables.

Conclusion: To the best of our knowledge, this study is the first to correlate the levels of endogenous CGRP in CSF with cognitive outcome in good-grade sSAH patients. Excessive CGRP release into CSF may have a negative short-term impact on quality of life, anxiety, and depression. While, subacute after sSAH, higher CSF levels of the vasodilator CGRP are supposed to be protective against vasospasm-associated cerebral ischemia, from a psychopathological point of view, our results suggest an involvement of CSF CGRP in the pathogenesis of neuropsychological deficits, at least in the short-term. The influence of cerebrovascular manipulation on CGRP release after sSAH has to be further elucidated.