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Abstract
Spontaneous intracerebral hemorrhage (ICH) causes, besides the primary brain injury, a secondary brain injury (SBI), which is induced, amongst other things, by oxidative stress (OS) and inflammation, determining the patient’s outcome. This study aims to assess the impact of OS in plasma and cerebrospinal fluid (CSF) on clinical outcomes in patients with ICH. A total of 19 ICH (volume > 30 cc) patients and 29 control patients were included. From day one until seven, blood and CSF samples were obtained, and ICH volume was calculated. OS markers, like malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione-sulfhydryl (GSH), and the total antioxidant status (TAS) were measured. Clinical data on treatment and outcome were determined. Patients with mRS ≤ 4 showed significantly elevated SOD and GSH-Px levels in plasma compared to patients with poor CO (p = 0.004; p = 0.002). Initial increased TAS in plasma and increased MDA in CSF were linked to an unfavorable outcome after six months (p = 0.06, r = 0.45; p = 0.05, r = 0.44). A higher ICH volume was associated with a worse outcome at week six (p = 0.04, r = 0.47). OS plays a significant role in SBI. Larger ICHs, elevated MDA in CSF, and TAS in plasma were associated with a detrimental outcome, whereas higher plasma-SOD and -GSH-Px were associated with a favorable outcome.
Highlights
Non-traumatic intracerebral hemorrhage (ICH) accounts for two million of all strokes (10–15%), with an incidence of 10–30 per 100,000 population per year worldwide [1]
Our study showed that increased superoxide dismutase (SOD) and GSH-Px plasma levels after ICH are
MDA levels were detected within the cerebrospinal fluid (CSF) in patients with larger ICH volumes, leading to an unfavorable outcome after six months
Summary
Non-traumatic intracerebral hemorrhage (ICH) accounts for two million of all strokes (10–15%), with an incidence of 10–30 per 100,000 population per year worldwide [1]. Despite an increasing number of studies, controversy persists concerning the benefit of surgical evacuation compared to conservative treatment of ICH [3]. Large clinical trials, such as the Surgical Trial in Intracerebral Hemorrhage (STICH I and STICH II) or the Minimally Invasive Surgery Plus. It is thought that the breakdown of hemoglobin to iron ions, heme, and thrombin induces the production of free radicals leading to direct neuronal damage [11]
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