Abstract
Background: Protein S100B has proven to be a useful biomarker for cerebral damages. Increased levels of serum and cerebrospinal fluid (CSF) S100B have been shown in patients suffering subarachnoid hemorrhage (SAH), severe head injury and stroke. In patients with SAH, the course of S100B levels has been correlated with neurological deficits and outcome. Cerebral vasospasm is a major contributor to morbidity and mortality. The primary aim of this study was to investigate the potential of S100B protein as a predictor of cerebral vasospasm in patients with severe SAH.Materials and Methods: Patients with SAH, Fisher grade 3 and 4, were included in the study. Five samples of CSF and serum S100B were collected from each patient. The first sample (baseline sample) was drawn within the first 3 days following ictus and the following four samples, once a day on days 5–8, with day of ictus defined as day 1. Clinical suspicion of cerebral vasospasm confirmed by computed tomography angiography was used to diagnose cerebral vasospasm.Results: A total of 18 patients were included. Five patients (28%) developed cerebral vasospasm, two (11%) developed ventriculitis. There were no significant differences between S100B for those with and without vasospasm. Serum S100B levels in patients with vasospasm were slightly lower within the first 5 days following ictus, compared to patients without vasospasm. Two out of five patients had elevated and increasing serum S100B prior to vasospasm. Only one showed a peak level of S100B 1 day before vasospasm could be diagnosed. Due to the low number of patients in the study, statistical significance could not be reached.Conclusion: Neither serum nor CSF S100B can be used as predictor of cerebral vasospasm in patients suffering from SAH.
Highlights
Subarachnoid hemorrhage (SAH) accounts for approximately 6– 8% of all strokes, and the leading cause is rupture of intracerebral aneurysms in 85% of the cases
Neither serum nor cerebrospinal fluid (CSF) S100B can be used as predictor of cerebral vasospasm in patients suffering from subarachnoid hemorrhage (SAH)
Cerebral vasospasm occur in approximately one third of aneurysmal SAH (aSAH) patients (Frontera et al, 2009), and the risk of vasospasm is related to the thickness and amount of blood in the subarachnoid space and/or the presence of intraventricular blood assessed on computed tomography (CT), the Fisher grade (Fisher et al, 1980; Jung et al, 2012)
Summary
Subarachnoid hemorrhage (SAH) accounts for approximately 6– 8% of all strokes, and the leading cause is rupture of intracerebral aneurysms in 85% of the cases. Mortality and morbidity is high, accounting for up to 50% in patients suffering from aneurysmal SAH (aSAH). Cerebral vasospasm is an important cause of morbidity and death after SAH (Rowland et al, 2012), for those who survive to receive medical treatment. It is defined as clinical neurological symptoms of ischemia (confusion, decreased level of consciousness, focal neurological deficits), with narrowing of cerebral vessels, visualized by computed tomography angiography (CTA). The primary aim of this study was to investigate the potential of S100B protein as a predictor of cerebral vasospasm in patients with severe SAH
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