Relationship between brain interstitial fluid tumor necrosis factor-α and cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
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.
Hanafy
Khalid A
KA
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
Stuart
R Morgan
RM
Khandji
Alexander G
AG
Connolly
E Sander
ES
Badjatia
Neeraj
N
Mayer
Stephan A
SA
Schindler
Christian
C
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*
D014409:Tumor Necrosis Factor-alpha
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