title: High ICP as trigger of proinflammatory IL-6 cytokine activation in aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  There is a rising debate about the role of inflammation in the pathogenesis of complications after aneurysmal subarachnoid hemorrhage (SAH) such as intracranial hypertension (intracranial pressure, ICP >20 mmHg). This study aimed to analyse the origin of interleukin-6 (IL-6) in respect to ICP and cerebral metabolism in SAH patients.
  
  
  METHODS
  Prospectively, IL-6 was measured in three compartments, the extracellular fluid (ECF) monitored by cerebral microdialysis (MD), cerebrospinal fluid (CSF) and plasma for 10 days after SAH (days 0-4, three times daily; days 5-10, two times daily). Patients were classified having intracranial hypertension (n=7) or normal ICP (n=17) during 10 days after bleeding. Glasgow outcome scale (GOS) was assessed after 3 and 6 months.
  
  
  RESULTS
  Patient groups were comparable for age, WFNS and Fisher grade. Intracranial hypertension was associated with an inflammatory response, indicating activation of the inflammatory cascade in the brain (ECF) and systemic circulation with high IL-6 and C-reactive protein (CRP) plasma levels after SAH, the latter associated with unfavourable outcome. The data suggest the ECF but not the CSF as main origin of IL-6 in the systemic circulation in the presence of intracranial hypertension in SAH.
  
  
  CONCLUSIONS
  Intracranial hypertension is associated with a strong activation of the inflammatory cascade in the brain and systemic circulation, and might be underestimated as proinflammmatory trigger in the pathogenesis of complications after SAH. Future therapies targeting anti-inflammatory response in plasma may help to reduce the inflammatory cascade responsible for development of intracranial hypertension.
authors.affiliation: Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Graetz
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nagel
authors.forename: Florian
authors.initials: F
authors.lastname: Schlenk
authors.forename: Oliver
authors.initials: O
authors.lastname: Sakowitz
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
authors.forename: Asita
authors.initials: A
authors.lastname: Sarrafzadeh
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007118:Immunoassay; D015850:Interleukin-6 / Q000097:blood* / Q000134:cerebrospinal fluid*; D019586:Intracranial Hypertension / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000209:etiology; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D018709:Statistics, Nonparametric; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000134:cerebrospinal fluid* / Q000150:complications
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein