Journal of Postgraduate Medicine, Education and Research

Register      Login

VOLUME 56 , ISSUE 3 ( July-September, 2022 ) > List of Articles

Original Article

Aneurysmal Subarachnoid Hemorrhage: Do Changes in Inflammatory Markers Precede or Succeed Symptomatic Vasospasm?

Sunil K Das, Navneet Singla, Sunil K Gupta, Kokkula Praneeth, Parth Jani, Ashish Aggarwal

Keywords : C-reactive protein levels, Inflammatory markers, Platelet count, Subarachnoid hemorrhage, Total leukocyte count, Vasospasm

Citation Information : Das SK, Singla N, Gupta SK, Praneeth K, Jani P, Aggarwal A. Aneurysmal Subarachnoid Hemorrhage: Do Changes in Inflammatory Markers Precede or Succeed Symptomatic Vasospasm?. J Postgrad Med Edu Res 2022; 56 (3):116-120.

DOI: 10.5005/jp-journals-10028-1590

License: CC BY-NC 4.0

Published Online: 01-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Vasospasm remains the most important predictor of outcome after aneurysmal subarachnoid hemorrhage (aSAH), especially in those who have undergone aneurysm occlusion. Vasospasm elicits an inflammatory response. The exact temporal course of levels of inflammatory markers vis-à-vis vasospasm remains a matter of debate, thus limiting its utility to be used as a predictive tool. Materials and methods: A total of 103 patients of aSAH, who underwent clipping/coiling were prospectively studied. Sequential values of total leukocyte count (TLC), platelet count, and C-reactive protein (CRP) were studied over a period of 2 weeks from the date of ictus. The temporal course of clinical vasospasm and inflammatory markers was then evaluated. Results: The mean age of the study group was 49.5 years. Thirty-three (32%) patients developed vasospasm. The mean day of onset of vasospasm was day 6. Age, gender, and site of aneurysm showed no significant bearing on the occurrence of vasospasm. Inflammatory markers-TLC, platelet count, and CRP levels were initially raised in both vasospasm and non-vasospasm groups. However, after day 10 the values became normal in the non-vasospasm group, but these remained persistently high in the vasospasm group. Conclusion: Persistent leukocytosis, thrombocytosis, and raised CRP beyond 7 days were found in vasospasm group. This period was beyond the mean period of onset of vasospasm. Raised CRP on day 3 seems to have a predictive value for the vasospasm.

PDF Share
  1. Biller J, Godersky JC, Adams Jr HP, et al. Management of aneurysmal subarachnoid hemorrhage. Stroke 1988;19(10):1300–1305. DOI: 10.1161/01.STR.19.10.1300
  2. Haley Jr EC, Kassell NF, Torner JC. The international cooperative study on the timing of aneurysm surgery. The North American experience. Stroke 1992;23(2):205–214. DOI: 10.1161/01.str.23.2.205
  3. Sobey CG, Faraci FM. Subarachnoid haemorrhage: what happens to the cerebral arteries? Clin Exp Pharmacol Physiol 1998;25(11):867–876. DOI: 10.1111/j.1440-1681.1998.tb02337.x
  4. Fassbender K, Hodapp B, Rossol S, et al. Inflammatory cytokines in subarachnoid haemorrhage: association with abnormal blood flow velocities in basal cerebral arteries. J Neurol Neurosurg Psychiatry 2001;70(4):534–537. DOI: 10.1136/jnnp.70.4.534
  5. Harrod CG, Bendok BR, Batjer HH. Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid hemorrhage: a review. Neurosurgery 2005;56(4):633–654. DOI: 10.1227/01.neu.0000156644.45384.92
  6. Jabbarli R, Gläsker S, Weber J, et al. Predictors of severity of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2013;22(8):1332–1339. DOI: 10.1016/j.jstrokecerebrovasdis.2013.01.006
  7. Charpentier C, Audibert G, Guillemin F, et al. Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 1999;30(7):1402–1408. DOI: 10.1161/01.str.30.7.1402
  8. Takemoto Y, Hasegawa Y, Hashiguchi A, et al. Predictors for functional outcome in patients with aneurysmal subarachnoid hemorrhage who completed in-hospital rehabilitation in a single institution. J Stroke Cerebrovasc Dis 2019;28(7):1943–1950. DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.042
  9. Kale SP, Edgell RC, Alshekhlee A, et al. Age-associated vasospasm in aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2013;22(1):22–27. DOI: 10.1016/j.jstrokecerebrovasdis.2011.05.024
  10. Oppong MD, Iannaccone A, Gembruch O, et al. Vasospasm-related complications after subarachnoid hemorrhage: the role of patients’ age and sex. Acta Neurochir (Wien) 2018;160(7):1393–1400. DOI: 10.1007/s00701-018-3549-1
  11. Frontera JA, Provencio JJ, Sehba FA, et al. The role of platelet activation and inflammation in early brain injury following subarachnoid hemorrhage. Neurocrit Care 2017;26(1):48–57. DOI: 10.1007/s12028-016-0292-4
  12. Romero FR, Cataneo DC, Cataneo AJM. C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage1. Acta Cir Bras 2014;29(5):340–345. DOI: 10.1590/s0102-86502014000500009
  13. Vergouwen MDI, Vermeulen M, Gijn JV, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 2010;41(10):2391–2395. DOI: 10.1161/STROKEAHA.110.589275
  14. Graf CJ, Nibbelink DW. Cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Report on a randomized treatment study. 3. Intracranial surgery. Stroke 1974;5(4):557–601. DOI: 10.1161/01.str.5.4.557
  15. Dumont T, Rughani A, Silver J, et al. Diabetes mellitus increases risk of vasospasm following aneurysmal subarachnoid hemorrhage independent of glycemic control. Neurocrit Care 2009;11(2):183–189. DOI: 10.1007/s12028-009-9232-x
  16. McGirt MJ, Mavropoulos JC, McGirt LY, et al. Leukocytosis as an independent risk factor for cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2003;98(6):1222–1226. DOI: 10.3171/jns.2003.98.6.1222
  17. Chugh C, Agarwal H. Cerebral vasospasm and delayed cerebral ischemia: review of literature and the management approach. Neurol India 2019;67(1):185–200. DOI: 10.4103/0028-3886.253627
  18. Romero FR, Cataneo DC, Cataneo AJM. C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage1. Acta Cir Bras 2014;29(5):340–350. DOI: 10.1590/s0102-86502014000500009
  19. Hirashima Y, Nakamura S, Endo S, et al. Elevation of platelet activating factor, inflammatory cytokines, and coagulation factors in the internal jugular vein of patients with subarachnoid hemorrhage. Neurochem Res 1997;22(10):1249–1255. DOI: 10.1023/a:1021985030331
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.