The amount of blood in CSF and degree of hydrocephalus studied with CT as compared to clinical condition and concentrations of various substances in human CSF after subarachnoid haemorrhage

Abstract

Thirty-nine (39) patients with subarachnoid haemorrhage (SAH) were studied with computed tomography (CT). The amount of blood in the cerebrospinal fluid (CSF) and the degree of hydrocephalus were evaluated. These two parameters were correlated with the clinical condition on admission and at discharge and against CSF concentration of a series of CSF substances. These included the major monoamine metabolites homovanillic acid (HVA), 5-hydroxyindole-acetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylethyleneglycol (MOPEG) and in addition the concentrations of hypoxanthine, aspartate and somatomedins. The amount of blood and the degree of hydrocephalus on admission did not seem to influence the concentration of these substances over time. It was found that patients with large amounts of blood in the CSF had a worse clinical outcome (p less than 0.05) compared to patients with no or moderate amount of blood. In addition, patients with enlargement of the temporal horns showed a worse clinical condition on admission (p less than 0.01) than did patients without such enlargement. Despite a significant (p less than 0.01) vasoconstriction there was no correlation between vascular calibre and concentration of the substances in the CSF. It is speculated whether or not the increased levels of these substances were the result of cell lysis per se, a disturbance of the CSF circulation or to the toxic effect of blood resulting in deranged metabolism in both the CSF and brain tissue after SAH.