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Cisternal and lumbar CSF levels of arachidonate metabolites after subarachnoid haemorrhage: An assessment of the biochemical hypothesis of vasospasm

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Summary

Several naturally occurring compounds have been identified in human cerebrospinal fluid (CSF) after subarachnoid haemorrhage (SAH) as possible vasoactive agents involved in the biochemical mechanism of vasospasm. The authors have measured, in 30 patients admitted for SAH, CSF concentrations of two arachidonic acid metabolites, Prostacyclin and Prostaglandin D2, as representative of vasodilator and vasoconstrictor compounds. CSF samples were made available by lumbar punctures and intraoperative cisternal punctures. Nine patients presented with symptomatic vasospasm: lumbar CSF Prostaglandin D2 levels are significantly higher than in patients without vasospasm. The Cisternal Prostaglandin D2 level is significantly higher than the lumbar CSF concentration; CSF Prostacyclin levels do not significantly differ in the two groups of patients. These data suggest the presence of an imbalanced biochemical situation responsible for promoting vasospasm. The evaluation of cisternal levels of arachidonate metabolites support the hypothesis of the clotting phenomenon around the ruptured aneurysm wall as an important predictive pattern of vasospasm onset after SAH, as shown in computed tomography.

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References

  1. Adams HP Jr, Kassell NF, Torner JC (1985) Usefulness of computed tomography in predicting outcome after subarachnoid hemorrhage. A preliminary report of the Cooperative Aneurysm Study. Neurology 35: 1263–1267

    PubMed  Google Scholar 

  2. Asano T, Tanishima T, Sasaki T, Sano K, Possible participation of free radical reactions initiated by clot lysis in the pathogenesis of vasospasm after subarachnoid hemorrhage. In: Wilkins RH (ed) Cerebral arterial spasm. Williams & Wilkins, Baltimore, pp 190–201

  3. Boullin, DJ, Du Boulay GH, Rogers AT (1978) Aetiology of cerebral arterial spasm following subarachnoid hemorrhage: evidence against a major involvement of 5-hidroxytryptamine in the production of acute spasm. Br J Clin Pharmacol 6: 203–215

    PubMed  Google Scholar 

  4. Boullin DJ, Brandt L, Ljunggren B, Tagari P (1981) Vasoconstrictor activity in cerebrospinal fluid from patients subjected to early surgery for ruptured intracranial aneurysm. J Neurosurg 55: 237–245

    PubMed  Google Scholar 

  5. Brandt L, Ljunggren B, Anderson KE, Hindfelt B (1981) Individual variations in response of human cerebral arterioles to vasoactive substances, human plasma, and CSF from patients with aneurysmal SAH. J Neurosurg 55: 431–437

    PubMed  Google Scholar 

  6. Fisher CM, Roberson GH, Ojemann RG (1977) Cerebral vasospasm with ruptured saccular aneurysm—the clinical manifestations. Neurosurgery 1: 245–248

    PubMed  Google Scholar 

  7. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9

    PubMed  Google Scholar 

  8. Gaetani P, Rodriguez y Baena R, Silvani V, Rainoldi F, Paoletti P (1986) Prostacyclin and vasospasm in subarachnoid hemorrhage from ruptured intracranial aneurysm. A clinical preliminary study. Acta Neurol Scand 73: 33–38

    PubMed  Google Scholar 

  9. Hunt W, Hess R (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20

    PubMed  Google Scholar 

  10. Kassell NF, Boarini DJ (1982) Cerebral ischemia in the aneurysm patient. Clin Neurosurg 29: 657–665

    PubMed  Google Scholar 

  11. Kassell NF, Sasaki T, Colohan ARI, Nazar G (1985) Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16: 562–572

    PubMed  Google Scholar 

  12. Kaye AH, Tagari PC, Teddy PJ, Adams CB, Blaso WP, Boullin DJ (1984) CSF smooth-muscle constrictor activity associated with cerebral vasospasm and mortality in SAH patients. J Neurosurg 60: 927–934

    PubMed  Google Scholar 

  13. Kistler JP, Crowell RM, Davis KR, Heros R, Ojemann RG, Fisher CM (1983) The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology 33: 424–436

    PubMed  Google Scholar 

  14. La Torre E, Patrono C, Fortuna A (1974) Role of PGF2-alpha in human cerebral vasospasm. J Neurosurg 41: 293–299

    PubMed  Google Scholar 

  15. Mizukami M, Kawase T, Usami T, Tazawa T (1982) Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10: 301–307

    PubMed  Google Scholar 

  16. Nizuma H, Kwak R, Otabe K, Suzuki J (1979) Angiography study of cerebral vasospasm following the rupture of intracranial aneurysms. II. Relation between the site of aneurysm and the occurrence of the vasospasm. Surg Neurol 11: 263–267

    PubMed  Google Scholar 

  17. Ohta H, Ito Z, Yasui N, Suzuki A (1982) Extensive evacuation of subarachnoid clot for prevention of vasospasm ... effective or not? Acta Neurochir (Wien) 63: 111–116

    Google Scholar 

  18. Ohta T, Kajikawa H, Yoshikawa Y, Shimizu K, Funatsu N, Yamamoto M, Toda N (1980) Cerebral vasospasm and hemoglobins: clinical and experimental studies. In: Wilkins RH (ed) Cerebral arterial spasm. Williams & Wilkins, Baltimore, pp 166–172

    Google Scholar 

  19. Okamoto S, Handa H, Toda N (1984) Role of intrinsic arachidonate metabolites in the vascular action of erythrocyte break-down products. Stroke 15: 60–64

    PubMed  Google Scholar 

  20. Osaka K (1977) Prolonged vasospasm produced by the break-down products of erythrocytes. J Neurosurg 47: 403–411

    PubMed  Google Scholar 

  21. Paul SK, Whalley ET, Forster C, Lye R, Dutton J (1982) Prostacyclin and cerebral vessel relaxation. J Neurosurg 57: 334–340

    PubMed  Google Scholar 

  22. Quintana L, Kouda R, Ishibashi Y, Yoshimoto T, Suzuki J (1982) The effect of prostacyclin on cerebral vasospasm. An experimental study. Acta Neurochir (Wien) 62: 187–193

    Google Scholar 

  23. Rodriguez y Baena R, Gaetani P, Folco G, Branzoli U, Paoletti P (1985) Cisternal and lumbar CSF concentration of arachidonate metabolites in vasospasm following subarachnoid hemorrhage from ruptured aneurysm. Surg Neurol 25: 428–432

    Google Scholar 

  24. Saito I, Ueda Y, Sano K (1977) Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47: 292, 429

    Google Scholar 

  25. Saito I, Shigeno T, Aritake K, Tanishima T, Sano K (1979) Vasospasm assessed by angiography and computerized tomography. J Neurosurg 51: 466–475

    PubMed  Google Scholar 

  26. Sano K, Asano T, Tanishima T, Sasaki T (1980) Lipid peroxidation as a cause of cerebral vasospasm. Neurol Res 2: 243–272

    Google Scholar 

  27. Sano K, Saito I (1980) Early operation and washout of blood clots for prevention of cerebral vasospasm. In: Wilkins RH (ed) Cerebral arterial spasm. Williams & Wilkins, Baltimore, pp 510–513

    Google Scholar 

  28. Sasaki T, Murota SI, Wakai S, Asano T, Sano K (1981) Evaluation of prostaglandin biosynthetic activity in canine basilar artery following subarachnoid injection of blood. J Neurosurg 55: 771–778

    PubMed  Google Scholar 

  29. Sasaki T, Asano T, Takakura K, Sano K, Kassell NF (1984) Nature of the vasoactive substance in CSF from patients with subarachnoid hemorrhage. J Neurosurg 60: 1186–1191

    PubMed  Google Scholar 

  30. Sundt TM Jr, Whisnant JP (1978) Subarachnoid hemorrhage from intracranial aneurysms: surgical management and natural history of disease. N Eng J Med 299: 116–122

    Google Scholar 

  31. Suzuki J, Komatsu S, Sato T, Sakurai Y (1980) Correlation between CT findings and subsequent development of cerebral infarction due to vasospasm in subarachnoid hemorrhage. Acta Neurochir (Wien) 55: 63–70

    Google Scholar 

  32. Suzuki N, Nakamura T, Imabayashi S, Ishikawa Y, Sasaki T, Asano T (1983) Identification of 5-hydroxy-eicosatetraenoic acid (5-HETE) in cerebrospinal fluid after subarachnoid hemorrhage. J Neurochem 41: 1186–1189

    PubMed  Google Scholar 

  33. Suzuki S, Iwabuchi T, Tanaka T, Kanayama S, Ottomo M, Hatanaka M, Aihara H (1985) Prevention of cerebral vasospasm with OKY-046 an Imidazole derivative and a thromboxane synthetase inhibitor. A preliminary co-operative clinical study. Acta Neurochir (Wien) 77: 133–141

    Google Scholar 

  34. Tanishima T (1980) Cerebral vasospasm: contractile activity of hemoglobin in isolated canine basilar arteries. J Neurosurg 53: 787–793

    PubMed  Google Scholar 

  35. Von Holst H, Granstrom E, Hammarstrom S, Samuelsson B, Steiner L (1982) Effect of Leucotrienes C4, D4, Prostacyclin and Thromboxane A2 on isolated human cerebral arteries. Acta Neurochir (Wien) 62: 177–185.

    Google Scholar 

  36. Walker V, Pickard JD, Smythe P, Eastwood S, Perry S (1983) Effects of subarachnoid hemorrhage on intracranial prostaglandins. J Neurol Neurosurg Psych 46: 119–125

    Google Scholar 

  37. Weir BKA (1980) The incidence and onset of vasospasm after subarachnoid hemorrhage from ruptured aneurysm. In: Wilkins RH (ed) Cerebral arterial spasm. Williams & Wilkins, Baltimore, pp 385–393

    Google Scholar 

  38. White RP (1983) Vasospasm I: Experimental findings. In: Fox JL (ed) Intracranial aneurysms. Springer, Heidelberg New York Tokyo, pp 218–249

    Google Scholar 

  39. White RP, Robertson JT (1985) Role of Plasmin, Thrombin and Antithrombin III as etiological factors in delayed cerebral vasospasm. Neurosurgery 16: 27–35

    PubMed  Google Scholar 

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Author notes

  1. R. Rodriguez y Baena

    Present address: Department of Surgery, Section of Neurosurgery and Center for the Study and Treatment of Cerebrovascular Diseases, University of Pavia, Italy

Authors and Affiliations

  1. Department of Surgery, Section of Neurosurgery and Center for the Study and Treatment of Cerebrovascular Diseases, University of Pavia, Italy

    P. Gaetani, V. Silvani & P. Paoletti

  2. Institute of Pharmacology and Pharmacognosy, University of Milan, Italy

    T. Viganó & M. T. Crivellari

Authors
  1. R. Rodriguez y Baena
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  2. P. Gaetani
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  3. V. Silvani
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  4. T. Viganó
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  5. M. T. Crivellari
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  6. P. Paoletti
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Additional information

This research was supported by a grant of the Italian Department of Instruction, Rome, Italy, 1984 and by a grant of Regione Lombardia.

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Rodriguez y Baena, R., Gaetani, P., Silvani, V. et al. Cisternal and lumbar CSF levels of arachidonate metabolites after subarachnoid haemorrhage: An assessment of the biochemical hypothesis of vasospasm. Acta neurochir 84, 129–135 (1987). https://doi.org/10.1007/BF01418838

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