Genetic determinants of cerebral vasospasm, delayed cerebral ischemia, and outcome after aneurysmal subarachnoid hemorrhage.
Despite extensive effort to elucidate the cellular and molecular bases for delayed cerebral injury after aneurysmal subarachnoid hemorrhage (aSAH), the pathophysiology of these events remains poorly understood. Recently, much work has focused on evaluating the genetic underpinnings of various diseases in an effort to delineate the contribution of specific molecular pathways as well as to uncover novel mechanisms. The majority of subarachnoid hemorrhage genetic research has focused on gene expression and linkage studies of these markers as they relate to the development of intracranial aneurysms and their subsequent rupture. Far less work has centered on the genetic determinants of cerebral vasospasm, the predisposition to delayed cerebral injury, and the determinants of ensuing functional outcome after aSAH. The suspected genes are diverse and encompass multiple functional systems including fibrinolysis, inflammation, vascular reactivity, and neuronal repair. To this end, we present a systematic review of 21 studies suggesting a genetic basis for clinical outcome after aSAH, with a special emphasis on the pathogenesis of cerebral vasospasm and delayed cerebral ischemia. In addition, we highlight potential pitfalls in the interpretation of genetic association studies, and call for uniformity of design of larger multicenter studies in the future.
Ducruet
Andrew F
AF
Department of Neurological Surgery, Columbia University, 630 West 168th Street, Room no. 5-454, New York, NY 10032, USA. afd12@columbia.edu
Gigante
Paul R
PR
Hickman
Zachary L
ZL
Zacharia
Brad E
BE
Arias
Eric J
EJ
Grobelny
Bartosz T
BT
Gorski
Justin W
JW
Mayer
Stephan A
SA
Connolly
E Sander
ES
D001921:Brain / Q000098:blood supply / Q000473:pathology; D002545:Brain Ischemia / Q000503:physiopathology*; D056726:Genetic Association Studies; D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000235:genetics / Q000503:physiopathology / Q000628:therapy