Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Significance of C-Reactive Protein and Transcranial Doppler in Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

  • Hwang, Sung-Hwan (Department of Neurosurgery, Chung-Ang University College of Medicine) ;
  • Park, Yong-Sook (Department of Neurosurgery, Chung-Ang University College of Medicine) ;
  • Kwon, Jeong-Taik (Department of Neurosurgery, Chung-Ang University College of Medicine) ;
  • Nam, Taek-Kyun (Department of Neurosurgery, Chung-Ang University College of Medicine) ;
  • Hwang, Sung-Nam (Department of Neurosurgery, Chung-Ang University College of Medicine) ;
  • Kang, Hyun (Medical Device Clinical Trials Center, Chung-Ang University College of Medicine)
  • Received : 2013.07.03
  • Accepted : 2013.09.30
  • Published : 2013.10.28
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Abstract

Objective : Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH. Methods : A total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks. Results : Serum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD. Conclusion : Patients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.

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References

  1. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. : Guidelines for the management of aneurysmal subarachnoid hemorrhage : a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 40 : 994-1025, 2009 https://doi.org/10.1161/STROKEAHA.108.191395
  2. Brisman JL, Song JK, Newell DW : Cerebral aneurysms. N Engl J Med 355 : 928-939, 2006 https://doi.org/10.1056/NEJMra052760
  3. Buckley DI, Fu R, Freeman M, Rogers K, Helfand M : C-reactive protein as a risk factor for coronary heart disease : a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann Intern Med 151 : 483-495, 2009 https://doi.org/10.7326/0003-4819-151-7-200910060-00009
  4. Chyatte D, Rusch N, Sundt TM Jr : Prevention of chronic experimental cerebral vasospasm with ibuprofen and high-dose methylprednisolone. J Neurosurg 59 : 925-932, 1983 https://doi.org/10.3171/jns.1983.59.6.0925
  5. Cotran RS : The endothelium and inflammation : new insights. Monogr Pathol : 18-37, 1982
  6. Crompton MR : The pathogenesis of cereral infarction following the rupture of cereral berry aneurysms. Brain 87 : 491-510, 1964 https://doi.org/10.1093/brain/87.3.491
  7. Dietrich HH, Dacey RG Jr : Molecular keys to the problems of cerebral vasospasm. Neurosurgery 46 : 517-530, 2000 https://doi.org/10.1097/00006123-200003000-00001
  8. Dumont AS, Dumont RJ, Chow MM, Lin CL, Calisaneller T, Ley KF, et al. : Cerebral vasospasm after subarachnoid hemorrhage : putative role of inflammation. Neurosurgery 53 : 123-133; discussion 133-135, 2003 https://doi.org/10.1227/01.NEU.0000068863.37133.9E
  9. Elkind MS, Luna JM, Moon YP, Liu KM, Spitalnik SL, Paik MC, et al. : High-sensitivity C-reactive protein predicts mortality but not stroke : the Northern Manhattan Study. Neurology 73 : 1300-1307, 2009 https://doi.org/10.1212/WNL.0b013e3181bd10bc
  10. Fountas KN, Tasiou A, Kapsalaki EZ, Paterakis KN, Grigorian AA, Lee GP, et al. : Serum and cerebrospinal fluid C-reactive protein levels as predictors of vasospasm in aneurysmal subarachnoid hemorrhage. Clinical article. Neurosurg Focus 26 : E22, 2009 https://doi.org/10.3171/2009.2.FOCUS08311
  11. Haley EC Jr, Kassell NF, Torner JC : The International Cooperative Study on the Timing of Aneurysm Surgery. The North American experience. Stroke 23 : 205-214, 1992 https://doi.org/10.1161/01.STR.23.2.205
  12. Hansen-Schwartz J : Cerebral vasospasm : a consideration of the various cellular mechanisms involved in the pathophysiology. Neurocrit Care 1 : 235-246, 2004 https://doi.org/10.1385/NCC:1:2:235
  13. Harrod CG, Bendok BR, Batjer HH : Prediction of cerebral vasospasm in patients presenting with aneurysmal subarachnoid hemorrhage : a review. Neurosurgery 56 : 633-654; discussion 633-654, 2005 https://doi.org/10.1227/01.NEU.0000156644.45384.92
  14. Hoshi T, Shimizu T, Kito K, Yamasaki N, Takahashi K, Takahashi M, et al. : [Immunological study of late cerebral vasospasm in subarachnoid hemorrhage. Detection of immunoglobulins, C3, and fibrinogen in cerebral arterial walls by immunofluorescence method]. Neurol Med Chir (Tokyo) 24 : 647-654, 1984 https://doi.org/10.2176/nmc.24.647
  15. Hughes JT, Schianchi PM : Cerebral artery spasm. A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage. J Neurosurg 48 : 515-525, 1978 https://doi.org/10.3171/jns.1978.48.4.0515
  16. Jeon YT, Lee JH, Lee H, Lee HK, Hwang JW, Lim YJ, et al. : The postoperative C-reactive protein level can be a useful prognostic factor for poor outcome and symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol 24 : 317-324, 2012 https://doi.org/10.1097/ANA.0b013e31826047a2
  17. Juvela S, Kuhmonen J, Siironen J : C-reactive protein as predictor for poor outcome after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 154 : 397-404, 2012 https://doi.org/10.1007/s00701-011-1243-7
  18. Kassell NF, Sasaki T, Colohan AR, Nazar G : Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16 : 562-572, 1985 https://doi.org/10.1161/01.STR.16.4.562
  19. Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL : The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1 : Overall management results. J Neurosurg 73 : 18-36, 1990 https://doi.org/10.3171/jns.1990.73.1.0018
  20. Kubo Y, Ogasawara K, Kakino S, Kashimura H, Tomitsuka N, Sugawara A, et al. : Serum inflammatory adhesion molecules and high-sensitivity C-reactive protein correlates with delayed ischemic neurologic deficits after subarachnoid hemorrhage. Surg Neurol 69 : 592-596; discussion 596, 2008 https://doi.org/10.1016/j.surneu.2008.02.014
  21. Lin CL, Jeng AY, Howng SL, Kwan AL : Endothelin and subarachnoid hemorrhage-induced cerebral vasospasm : pathogenesis and treatment. Curr Med Chem 11 : 1779-1791, 2004 https://doi.org/10.2174/0929867043364919
  22. Mizukami M, Kawase T, Tazawa T, Nagata K, Yunoki K, Yoshida Y : Hypothesis and clinical evidence for the mechanism of chronic cerebral vasospasm after subarachnoid hemorrhage. Cerebral Arterial Spasm. Baltimore : Williams & Wilkins, 1980, pp97-112
  23. Nordestgaard BG, Zacho J : Lipids, atherosclerosis and CVD risk : is CRP an innocent bystander? Nutr Metab Cardiovasc Dis 19 : 521-524, 2009 https://doi.org/10.1016/j.numecd.2009.07.005
  24. Pinckard RN : The "new" chemical mediators of inflammation. Monogr Pathol : 38-53, 1982
  25. Pluta RM : Delayed cerebral vasospasm and nitric oxide : review, new hypothesis, and proposed treatment. Pharmacol Ther 105 : 23-56, 2005 https://doi.org/10.1016/j.pharmthera.2004.10.002
  26. Rodríguez García PL, Rodríguez Pupo LR, Rodríguez García D : [Diagnosis of delayed cerebral ischaemia and cerebral vasospasm in subarachnoid haemorrhage]. Neurologia 25 : 322-330, 2010 https://doi.org/10.1016/j.nrl.2009.12.006
  27. Rothoerl RD, Axmann C, Pina AL, Woertgen C, Brawanski A : Possible role of the C-reactive protein and white blood cell count in the pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol 18 : 68-72, 2006 https://doi.org/10.1097/01.ana.0000181693.30750.af
  28. Schievink WI : Intracranial aneurysms. N Engl J Med 336 : 28-40, 1997 https://doi.org/10.1056/NEJM199701023360106
  29. Towart R : The pathophysiology of cerebral vasospasm, and pharmaco-logical approaches to its management. Acta Neurochir (Wien) 63 : 253-258, 1982 https://doi.org/10.1007/BF01728879
  30. Umemoto S, Suzuki N, Fujii K, Fujii A, Fujii T, Iwami T, et al. : Eosinophil counts and plasma fibrinogen in patients with vasospastic angina pectoris. Am J Cardiol 85 : 715-719, 2000 https://doi.org/10.1016/S0002-9149(99)00846-2
  31. Weir B, Okwuasaba F, Cook D, Krueger C : Pharmacology of vasospasm-Effects of various agents including blood on isolated cerebral arteries. Cerebral arterial spasm. Baltimore : Williams and Wilkins, 1980, pp237-243
  32. White RP, Robertson JT : Comparison of piroxicam, meclofenamate, ibuprofen, aspirin, and prostacyclin efficacy in a chronic model of cerebral vasospasm. Neurosurgery 12 : 40-46, 1983 https://doi.org/10.1227/00006123-198301000-00008
  33. Yamashima T, Yamamoto S : Cerebral arterial pathology in experimental subarachnoid hemorrhage. J Neurosurg 58 : 843-850, 1983 https://doi.org/10.3171/jns.1983.58.6.0843

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