[Subarachnoid hemorrhage, cerebral ischemia and endothelin-1].
BACKGROUND
Cerebral vasospasm is involved in the development of delayed ischemic lesions in patients with subarachnoid hemorrhage. We developed an integral theoretical model to explain the pathophysiology of cerebral vasospasm, in which endothelin-1 has a pivotal role in the development of both cerebral vasospasm and delayed ischemic neurological deficits (DIND).


OBJECTIVE
The objective of this study is to analyze the relationship between temporal profile of plasma endothelin-1 levels and the development of cerebral vasospasm and DIND.


METHODS
We analyzed sequentially plasma endothelin-1 levels in 17 patients with aneurysmatic subarachnoid hemorrhage. All the patients had complete clinical and neuroradiological studies. Patients were classified according to Fisher's score.


RESULTS
Patients (4 males and 13 females, aged 48.1 +/- 20.3 years) had a good clinical condition (Hunt-Hess < 4, GCS > 10). Two weeks after bleeding, patients had higher plasma endothelin-1 levels than healthy volunteers (p = 0.024). Patients who developed DIND had higher plasma endothelin-1 levels (p = 0.034) and a different evolution (p = 0.0146) than patients without DIND. There is a significant correlation (p = 0.02) between basal plasma endothelin-1 levels and GOS score. Multiple regression analysis shows a significant dependence between plasma endothelin-1 levels and Fisher's score (p = 0.0195), development of DIND (p = 0.0095), and GOS score (p = 0.0319). Logistic regression analysis finds a predictive relation between Fisher's score and plasma endothelin-1 levels for the development of DIND (overall predicted = 74.24%; p = 0.0148).


CONCLUSIONS
Plasma endothelin-1 levels are increased in patients after subarachnoid hemorrhage and are associated with the development of cerebral vasospasm and DIND.
Secades
J J
JJ
Departamento de Neurocirugía, Hospitals de la Vall d'Hebron, Universidad Autónoma de Barcelona, España. 19891jsr@comb.es
Rubio
E
E
Castellanos
J M
JM
de la Rosa
M D
MD
Mercadal
J
J
Vilalta
J
J
Catalán
R
R
Galard
R M
RM
D000368:Aged; D000918:Antibody Specificity / Q000276:immunology; D002545:Brain Ischemia / Q000097:blood / Q000209:etiology*; D019332:Endothelin-1 / Q000097:blood* / Q000276:immunology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011863:Radioimmunoassay; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000097:blood* / Q000150:complications* / Q000503:physiopathology
D019332:Endothelin-1