| Object: Cerebral vasospasm constitutes a major complication of subarachnoid hemorrhage (SAH). The pathogenesis of cerebral vasospasm is unclear, in spite of intensive investigations conducted over the past years. Even though multiple factors are proposed to be involved in cerebral vasospasm, oxyhemoglobin (OxyHb) is one of the most important spasmogens for cerebral vasospasm that fallows aneurismal SAH. The cytotoxic effect of OxyHb has been documented in endomelial and smooth-muscle; This study was undertaken to investigate the temporal change in cerebrospinal fluid concentration of OxyHb, deoxyhemoglobin (DeoxyHb), methemoglobin (MetHb) and diagnosis of vasospasm by transcranial dopple (TCD) in patients after SAH.Methods: 30 patients admited within 24h after SAH were selected, 3 patients of these were eliminated because of rebleeding. the CSF of 27 patients were collected in 1, 3, 5, 7, 10, 14 day, levels of OxyHb, DeoxyHb and MetHb were measured by means of spectrophotomery. The blood velocities of the middle cerebral artery (MCA) weremeasured by TCD at the same time.Results: Concentration of OxyHb increased in Day 3 and peaked on Day 7 in patients after SAH, P<0.05 compared with the levels of Days 1, 3, 14; Concentration of DeoxyHb peaked on Day 7 in patients P<0.05 compared with the levels of Days 1, 3, 5,14; MetHb levels increased only slightly, peaked on Day 14. Flow velocities of MCA increased on Day 5 and peaked on Day 7. The correlation analysis of concentration of OxyHb to flow velocities of MCA is significative.Conclusions: This study provides in clinical evidence that the concentration of OxyHb and DeoxyHb increase in CSF during the development of delayed cerebral vasospam. The results support the hypothesis that OxyHb is involve in the pathogenesis of delayed cerebral vasospam after SAH and implicate DeoxyHb as a possible vasoapastic agent. The TCD technique can detect increased velocities in the MCA , and correlated with concentration of OxyHb. |
PDF Full Text Request