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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Correlations between cytokine-concentrations in ventricular CSF, Doppler-sonography findings and radiographic cerebral blood flow measuring after spontaneous subarachnoid hemorrhage

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  • T. Kapapa - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • A. Gardill - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • P. Broer - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • H. Tumani - Klinik für Neurologie, Universitätsklinikum Ulm, Ulm
  • V. Lehmensiek - Klinik für Neurologie, Universitätsklinikum Ulm, Ulm
  • M. Schneider - Klinik für Anästhesiologie, Sektion experimentelle Anästhesie, Universitätsklinikum Ulm, Ulm
  • M. Weiss - Klinik für Anästhesiologie, Sektion experimentelle Anästhesie, Universitätsklinikum Ulm, Ulm
  • B. Schmitz - Sektion Neuroradiologie, Universitätsklinikum Ulm, Ulm
  • R. König - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • T. Schmidt - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • C. Heinen - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • S. Röhrer - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • C.R. Wirtz - Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ulm
  • D. Woischneck - Klinik für Neurochirurgie, Klinikum Landshut, Landshut

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 048

doi: 10.3205/11dgnc269, urn:nbn:de:0183-11dgnc2692

Published: April 28, 2011

© 2011 Kapapa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The equilibrium theory describes a disturbed homeostasis between vasoconstrictive and -dilatative factors in cerebrospinal fluid after the influx of blood after spontaneous hemorrhage. Intra- and extracellular processes try to sustain or restore homeostasis. Within these, immunological processes have special roles. We present courses of cytokine-concentrations in analogy to the "cardiac enzymes" after myocardial infarction and perform correlations with radiological results for cerebral blood flow.

Methods: Endothelin-1 (ET1), Interleukine-1β (IL1), Interleukine-6 (IL6) and Tumor-Necrosis-Factor Alpha (TNFα) was measured at six-hour intervals via ventricular CSF drainage and arterial blood in patients with spontaneous subarachnoid hemorrhage (proved by computed tomography or lumbar puncture). Their concentrations were determined by ELISA. Doppler-sonography examinations of intracranial vessels were performed at the same intervals. MRI measurement of blood flow (mean transit time, time-to-peak and MR-angiography) was performed at days 3 and 7 as well as in the presence of clinical or sonographic signs (> 120cm/sec.) of cerebral vasospasm. The period of investigation lasted a maximum of 12 days after hemorrhage (max. 45 probes of liquor and serum).

Results: The results of the first 15 patients represent an increase of IL-6 and IL-1 concentrations within the first 24 hours (p=0,001) and after 72 hours (p=0.0001). A concentration could be found after 114 hours. Patients with vasospasm had an earlier but lower peak level in IL-6 (p=0.0001). Concentrations of IL-1 in patients with and without vasospasm increase over the same course of time. However, there is a significant difference between the initial concentrations within the first 24 hours. Patients without vasospasm had higher initial concentrations (p=0.0001). The time-point of the first increased Doppler-sonographic result correlates with the increase in IL-6 concentrations (r=0.4, p=0.043). There are significant deficits in cerebral perfusion in 6 of 7 patients with elevated Doppler-sonographic results und increased concentrations of IL-6 and IL-1.

Conclusions: The equilibrium theory seemed to be partly confirmed by our findings. The radiographic and clinical results correlate significantly with the course of concentrations in cytokines. We will include and recruit more patients and cytokines for the cytokine card after spontaneous subarachnoid hemorrhage.