title: Experimental subarachnoid haemorrhage results in multifocal axonal injury.
abstract: The great majority of acute brain injury results from trauma or from disorders of the cerebrovasculature, i.e. ischaemic stroke or haemorrhage. These injuries are characterized by an initial insult that triggers a cascade of injurious cellular processes. The nature of these processes in spontaneous intracranial haemorrhage is poorly understood. Subarachnoid haemorrhage, a particularly deadly form of intracranial haemorrhage, shares key pathophysiological features with traumatic brain injury including exposure to a sudden pressure pulse. Here we provide evidence that axonal injury, a signature characteristic of traumatic brain injury, is also a prominent feature of experimental subarachnoid haemorrhage. Using histological markers of membrane disruption and cytoskeletal injury validated in analyses of traumatic brain injury, we show that axonal injury also occurs following subarachnoid haemorrhage in an animal model. Consistent with the higher prevalence of global as opposed to focal deficits after subarachnoid haemorrhage and traumatic brain injury in humans, axonal injury in this model is observed in a multifocal pattern not limited to the immediate vicinity of the ruptured artery. Ultrastructural analysis further reveals characteristic axonal membrane and cytoskeletal changes similar to those associated with traumatic axonal injury. Diffusion tensor imaging, a translational imaging technique previously validated in traumatic axonal injury, from these same specimens demonstrates decrements in anisotropy that correlate with histological axonal injury and functional outcomes. These radiological indicators identify a fibre orientation-dependent gradient of axonal injury consistent with a barotraumatic mechanism. Although traumatic and haemorrhagic acute brain injury are generally considered separately, these data suggest that a signature pathology of traumatic brain injury-axonal injury-is also a functionally significant feature of subarachnoid haemorrhage, raising the prospect of common diagnostic, prognostic, and therapeutic approaches to these conditions.
authors.affiliation: 1 Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA kummert@neuro.wustl.edu.
authors.forename: Terrance T
authors.initials: TT
authors.lastname: Kummer
authors.affiliation: 2 Department of Anaesthesiology and Intensive Care, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza, 33, 20122, Milan, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Magnoni
authors.affiliation: 1 Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA.
authors.forename: Christine L
authors.initials: CL
authors.lastname: MacDonald
authors.affiliation: 3 Department of Anatomy and Neurobiology, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA.
authors.forename: Krikor
authors.initials: K
authors.lastname: Dikranian
authors.affiliation: 4 Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Milner
authors.affiliation: 1 Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA.
authors.forename: James
authors.initials: J
authors.lastname: Sorrell
authors.affiliation: 2 Department of Anaesthesiology and Intensive Care, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza, 33, 20122, Milan, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Conte
authors.affiliation: 1 Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA.
authors.forename: Joey J
authors.initials: JJ
authors.lastname: Benetatos
authors.affiliation: 4 Department of Neurosurgery, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
authors.affiliation: 1 Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, Saint Louis, Missouri, 63110, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Brody
mesh_terms: D016229:Amyloid beta-Peptides / Q000378:metabolism; D000818:Animals; D001369:Axons / Q000000981:diagnostic imaging / Q000473:pathology*; D001921:Brain / Q000378:metabolism / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology*; D056324:Diffusion Tensor Imaging; D004195:Disease Models, Animal; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D051379:Mice; D008810:Mice, Inbred C57BL; D046529:Microscopy, Electron, Transmission; D016900:Neurofilament Proteins / Q000378:metabolism; D013223:Statistics as Topic; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000473:pathology; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D016229:Amyloid beta-Peptides; D016900:Neurofilament Proteins; C051774:neurofilament protein H
keywords: axonal injury; brain haemorrhage; diffusion tensor imaging; subarachnoid haemorrhage; traumatic brain injury