Aneurysmal Subarachnoid Hemorrhage: Do Changes in Inflammatory Markers Precede or Succeed Symptomatic Vasospasm?

JOURNAL TITLE: Journal of Postgraduate Medicine, Education and Research

Author
1. Sunil K Das
2. Ajay Kumar
3. Kokkula Praneeth
4. Navneet Singla
5. Parth Jani
6. Ashish Aggarwal
7. Sunil K Gupta
ISSN
2277-8969
DOI
10.5005/jp-journals-10028-1590
Volume
56
Issue
3
Publishing Year
2022
Pages
5
Author Affiliations
    1. Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
    1. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
    1. Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh
    1. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
    1. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
    1. Postgraduate Institute of Medical Education and Research Chandigarh
    2. Indraprastha Apollo Hospital, New Delhi, India
    3. PGIMER, Chandigarh, India
    4. Children Hospital of Michigan School of Medicine, Wayne State University, 3901 Beaubien, Street, Detroit MI, 48201, USA
    5. Patna, Bihar, India
    6. All India Institute of Medical Sciences, New Delhi, India
    7. All India Institute of Medical Sciences, New Delhi
    8. Kalawati Saran Children’s Hospital and Lady Hardinge Medical College, New Delhi, India
    9. Diabetes Care and Research Center, Patna, Bihar, India
    10. Diabetes Care and Research Centre, Patna 800 020, Bihar, India
    11. Diabetes Care and Research Centre, Patna, Bihar, India
    12. Lady Hardinge Medical College and Kalawati Saran Children’s Hospital, New Delhi, India
    13. Fortis Escorts Liver and Digestive Disease Institute, Fortis Escorts Heart Institute, New Delhi, India
    14. Medanta–The Medicity, Gurgaon, Haryana, India
    15. Postgraduate Institute of Medical Education and Research, Chandigarh, India
    16. Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
    17. Diabetes Care and Research Centre, GCIB, Patna, India
    18. BLK Liver and Digestive Diseases Institute, New Delhi, India
  • Article keywords
    C-reactive protein levels, Inflammatory markers, Platelet count, Subarachnoid hemorrhage, Total leukocyte count, Vasospasm

    Abstract

    Background: Vasospasm remains the most important predictor of outcome after aneurysmal subarachnoid hemorrhage (aSAH), especially in those who have undergone aneurysm occlusion. Vasospasm elicits an inflammatory response. The exact temporal course of levels of inflammatory markers vis-à-vis vasospasm remains a matter of debate, thus limiting its utility to be used as a predictive tool. Materials and methods: A total of 103 patients of aSAH, who underwent clipping/coiling were prospectively studied. Sequential values of total leukocyte count (TLC), platelet count, and C-reactive protein (CRP) were studied over a period of 2 weeks from the date of ictus. The temporal course of clinical vasospasm and inflammatory markers was then evaluated. Results: The mean age of the study group was 49.5 years. Thirty-three (32%) patients developed vasospasm. The mean day of onset of vasospasm was day 6. Age, gender, and site of aneurysm showed no significant bearing on the occurrence of vasospasm. Inflammatory markers-TLC, platelet count, and CRP levels were initially raised in both vasospasm and non-vasospasm groups. However, after day 10 the values became normal in the non-vasospasm group, but these remained persistently high in the vasospasm group. Conclusion: Persistent leukocytosis, thrombocytosis, and raised CRP beyond 7 days were found in vasospasm group. This period was beyond the mean period of onset of vasospasm. Raised CRP on day 3 seems to have a predictive value for the vasospasm.

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