Cerebrospinal fluid ferritin in chronic hydrocephalus after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Subarachnoid hemorrhage (SAH) is a common cause of chronic hydrocephalus. Blood in the subarachnoid space is intracranially metabolized to bilirubin and iron, and free iron is thereafter detoxified by ferritin. However, no studies have reported the relationship between intracranial heme metabolism and chronic hydrocephalus after SAH. The goal of this prospective study was to clarify the relationship between intracranial heme metabolism and chronic hydrocephalus after SAH.


METHODS
The authors measured the levels of bilirubin, iron and ferritin in the cerebrospinal fluid (CSF) of 70 consecutive patients with aneurysmal SAH of Fisher computed tomography Group III, and determined the relationship between these substances' levels and hydrocephalus requiring ventriculoperitoneal shunting.


RESULTS
The CSF concentrations of ferritin and inflammatory cells were significantly higher in shunted patients (n = 27) than in non-shunted patients (n = 43) on Days 3 and 4 (p < 0.05 in ferritin and p < 0.01 in inflammatory cells) and 11 to 14 (p < 0.005 in ferritin) post-SAH. These results were independent of other clinical factors. The occurrence of chronic hydrocephalus was not affected by the extent of the intracranial heme metabolism in terms of the bilirubin and iron levels.


CONCLUSIONS
This is the first study to show that patients who subsequently had chronic hydrocephalus requiring CSF shunting were associated with higher CSF levels of ferritin in the acute stage of SAH. Higher CSF ferritin levels may not reflect the amount of blood in the subarachnoid space that was intracranially metabolized, but rather more intense subarachnoid inflammatory reactions which may cause chronic hydrocephalus after SAH.
Suzuki
Hidenori
H
Department of Neurosurgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu Mie, 514-8507, Japan. suzuki02@clin.medic.mie-u.ac.jp
Muramatsu
Masatoshi
M
Tanaka
Katsuhiro
K
Fujiwara
Hiroaki
H
Kojima
Tadashi
T
Taki
Waro
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005293:Ferritins / Q000134:cerebrospinal fluid*; D006418:Heme / Q000134:cerebrospinal fluid; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000209:etiology* / Q000473:pathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000473:pathology; D013997:Time Factors
D006418:Heme; D005293:Ferritins