Abstract
BackgroundThe implication of the steroids estradiol, progesterone and testosterone in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) has not been comprehensively assessed. In rodents, studies suggested beneficial effects of steroids on cerebral vasospasm after experimental SAH. Studies in humans are warranted, however, a general dilemma of human studies on neuroactive substances is that the brain is not directly accessible and that concentrations in the periphery may not adequately parallel concentrations in the central compartments. In the present study, concentrations of estradiol, progesterone and testosterone in serum and cerebrospinal fluid (CSF) of patients with aSAH were determined. Blood flow velocities in cerebral arteries were measured by transcranial Doppler sonography (TCD). The aim of this study was to evaluate the correlations between the cerebral blood flow velocities and levels of estradiol, progesterone and testosterone in CSF and serum.ResultsSamples of serum and CSF of 42 patients with aSAH were collected concomitantly daily or every other day via the arterial line and the external ventricular drainage for two weeks after the hemorrhage. Blood flow velocities in the cerebral arteries were determined by TCD. Total estradiol, progesterone and testosterone concentrations were measured by electro-chemiluminescence immunoassay. The strength of correlation was assessed by Spearman’s rank correlation coefficient. The correlation analysis revealed very weak correlations between cerebral blood flow velocities and concentrations of estradiol, progesterone and testosterone levels in both compartments with correlation coefficients below 0.2.ConclusionsIn humans with aSAH, merely very weak correlations between flow velocities in cerebral arteries and concentrations of estradiol, progesterone and testosterone in serum and CSF were demonstrated. These results suggest a limited influence of the respective steroids on cerebral vascular tone although vasodilatory effects were described in rodent studies. Thus, the implication of steroids in processes of neurological deterioration warrants further clarification.
Highlights
The implication of the steroids estradiol, progesterone and testosterone in cerebral vasospasm after aneurysmal subarachnoid hemorrhage has not been comprehensively assessed
Steroids appear involved in these processes but it is still largely unsettled to what extent the steroids estradiol, progesterone and testosterone have an influence on the development or degree of cerebral vasospasm
Given numerous studies in rodents on steroids, predominantly estradiol, and its association with cerebral vasospasm after experimental subarachnoid hemorrhage (SAH), the idea that steroids might be involved in processes linked to cerebral vasospasm or functional outcome remains to be investigated in more detail
Summary
The implication of the steroids estradiol, progesterone and testosterone in cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) has not been comprehensively assessed. Concentrations of estradiol, progesterone and testosterone in serum and cerebrospinal fluid (CSF) of patients with aSAH were determined. The aim of this study was to evaluate the correlations between the cerebral blood flow velocities and levels of estradiol, progesterone and testosterone in CSF and serum. Several studies assessed the potentially beneficial effects of these steroids on cerebral vasospasm after experimental subarachnoid hemorrhage (SAH) [2, 4, 5]. A further knowledge of the implication of estradiol, progesterone and testosterone in differing compartments, such as blood, cerebrospinal fluid (CSF) and brain parenchyma in influencing cerebral vasospasm may help to understand factors underlying its pathogenesis or unveil therapeutic options. Human CSF is not obtained and normally invasive techniques such as lumbar puncture or ventricular drainage are needed whereby the latter is often performed in aSAH patients as a therapeutic measure
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