title: Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: Tumor necrosis factor-alpha (TNF-alpha) has a crucial role in the onset of hemolysis-induced vascular injury and cerebral vasoconstriction. We hypothesized that TNF-alpha measured from brain interstitial fluid would correlate with the severity of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). From a consecutive series of 10 aSAH patients who underwent cerebral microdialysis (MD) and evaluation of vasospasm by CT angiogram (CTA) or digital subtraction angiography (DSA), TNF-alpha levels from MD were measured at 8-hour intervals from aSAH days 4-6 using enzyme-linked immunosorbent assay. An attending neuroradiologist blinded to the study independently evaluated each CTA and DSA and assigned a vasospasm index (VI). Five patients had a VI<2 and 5 patients had a VI>2, where the median VI was 2 (range 0-13). The median log TNF-alpha area under the curve (AUC) was 1.64pg/mL *day (interquartile range 1.48-1.71) for the VI<2 group, and 2.11pg/mL *day (interquartile range 1.95-2.47) for the VI>2 group (p<0.01). Thus, in this small series of poor-grade aSAH patients, the AUC of TNF-alpha levels from aSAH days 4-6 correlates with the severity of radiographic vasospasm. Further analysis in a larger population is warranted based on our preliminary findings.
authors.affiliation: Columbia University Medical Center, Division of Neurocritical Care, Columbia University College of Physicians and Surgeons, Milstein Hospital Room 8GS-331, New York, New York 10032, USA. kh2401@columbia.edu
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Hanafy
authors.forename: R Morgan
authors.initials: RM
authors.lastname: Stuart
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Khandji
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000378:metabolism* / Q000473:pathology; D045604:Extracellular Fluid / Q000737:chemistry / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D017551:Microdialysis / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000502:physiology*; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*
chemical_list: D014409:Tumor Necrosis Factor-alpha
references.citation: J Neurosurg. 1998 Feb;88(2):277-84
references.pmid: 9452236
references.citation: J Cereb Blood Flow Metab. 2001 Sep;21(9):1067-76
references.pmid: 11524611
references.citation: Clin Radiol. 2005 Sep;60(9):1030-6
references.pmid: 16124986
references.citation: J Neurosurg. 2000 Nov;93(5):808-14
references.pmid: 11059662
references.citation: Scand J Clin Lab Invest Suppl. 1999;229:9-18
references.pmid: 10097285
references.citation: J Neurosurg. 2008 Mar;108(3):458-63
references.pmid: 18312091
references.citation: J Neurochem. 2009 May;109 Suppl 1:24-9
references.pmid: 19393005
references.citation: J Neurol Neurosurg Psychiatry. 2001 Oct;71(4):455-61
references.pmid: 11561027
references.citation: AJNR Am J Neuroradiol. 2004 May;25(5):819-26
references.pmid: 15140728
references.citation: J Neurol Neurosurg Psychiatry. 2001 Apr;70(4):534-7
references.pmid: 11254783
references.citation: Acta Neurochir (Wien). 1990;102(3-4):91-7
references.pmid: 1970920
references.citation: Vasc Health Risk Manag. 2008;4(4):805-17
references.pmid: 19065997
references.citation: J Cereb Blood Flow Metab. 2007 Sep;27(9):1583-92
references.pmid: 17293842
references.citation: AJNR Am J Neuroradiol. 2004 Jun-Jul;25(6):1067-76
references.pmid: 15205150
references.citation: Br J Cancer. 1987 Dec;56(6):803-8
references.pmid: 3435706
references.citation: Crit Care Med. 2002 May;30(5):1062-70
references.pmid: 12006804
references.citation: Neurosurgery. 2001 Dec;49(6):1341-8; discussion 1348-50
references.pmid: 11846933
references.citation: Electroencephalogr Clin Neurophysiol. 1997 Dec;103(6):607-15
references.pmid: 9546487
references.citation: Acta Neurochir Suppl. 2001;77:145-7
references.pmid: 11563274
references.citation: J Neurosurg. 1997 Dec;87(6):830-5
references.pmid: 9384391
references.citation: Methods Mol Biol. 1995;42:1-218
references.pmid: 7655571
references.citation: Stroke. 2001 Sep;32(9):2012-20
references.pmid: 11546890
references.citation: Neurology. 2003 Jan 28;60(2):208-14
references.pmid: 12552032
references.citation: Arch Immunol Ther Exp (Warsz). 2009 Mar-Apr;57(2):137-40
references.pmid: 19340565
references.citation: J Cereb Blood Flow Metab. 2006 Nov;26(11):1341-53
references.pmid: 16482081
references.citation: Neurosurgery. 1982 Sep;11(3):337-43
references.pmid: 7133349
references.citation: J Neurosurg. 1996 Mar;84(3):405-14
references.pmid: 8609551
references.citation: Circulation. 2007 Dec 11;116(24):2830-40
references.pmid: 18025535
references.citation: J Neurosurg. 1978 Feb;48(2):173-8
references.pmid: 624965
references.citation: J Cereb Blood Flow Metab. 1996 Jul;16(4):637-44
references.pmid: 8964803
references.citation: Stroke. 1988 Oct;19(10):1250-6
references.pmid: 3176085
references.citation: Stroke. 2004 Mar;35(3):638-43
references.pmid: 14963287
references.citation: J Neurosurg. 2002 Jun;96(6):1013-9
references.pmid: 12066900
references.citation: Stroke. 1999 Jul;30(7):1402-8
references.pmid: 10390314
references.citation: Clin Neurosurg. 1982;29:657-65
references.pmid: 7172572
references.citation: Neurocrit Care. 2006;4(2):103-12
references.pmid: 16627897
references.citation: Stroke. 1999 Nov;30(11):2268-71
references.pmid: 10548655
references.citation: Hypertension. 2009 Jul;54(1):150-6
references.pmid: 19470883
references.citation: J Neurol Sci. 2007 Oct 15;261(1-2):134-42
references.pmid: 17570400
references.citation: AJNR Am J Neuroradiol. 2002 Sep;23(8):1284-90
references.pmid: 12223366
references.citation: Stroke. 2009 Mar;40(3):994-1025
references.pmid: 19164800
references.citation: J Neurosurg. 1997 Aug;87(2):215-20
references.pmid: 9254084