The investigation of cytokine level in cerebrospinal fluid and serum in the case of subarachnoid hemorrhage and the following cerebral vasospasm and delayed ischemic deficit

ABSTRACT The Investigation of Cytokine Level in Cerebrospinal Fluid and Serum in The Case of Subarachnoid Hemorrhage and The Following Cerebral Vasospasm and Delayed Ischemic Deficit. Vasospasm, following Subarachnoid hemorrhage (SAH) can be defined as narrowing of vascular branch of the brain. Cerebral Vasospasm pathophysiological mechanisms could not be understood clearly. Spasmatogenic factors which is responsible of vasospasm following SAH could be found out. And a lot of factors have been responsible of this case. We detected the effect against the vasospasm of the amount of SAH in CT (Fisher grade), the neurologic grade (Hunt-Hess grade) during the admittion of the patient and one of the factors which is immnoreactive process. We researched the effect of cytokines, especially the interleukin (IL-6) and Interleukin-8 (IL-8), in SAH position and the following vasospasm process. We selected the patients who applied to our clinic in a few hours the beginning of symptoms after SAH to neurosurgery intensive care unit between April 2004 and August 2004 dates. The diagnosis of SAH has been established by computerized tomographic (CT) scan and Lumbar Puncture (LP). When the cases were admitted to the intensive care unit the first neurologic exaniinations of them were made as Hunt-Hess classification and the same patients' the amount of SAH in CT as fisher classification. We took from the ten patients 50 serum and 50 Cerebrospinal Fluid (CSF) samples in 1., 3., 5., 7. and 9. days after SAH. As a control group. We also studied 10 people who did not have evidence with vascular disease, nerve system trauma or inflamatuar disease. We took 10 CSF and serum sample from the control group. In these taken samples, we studied the levels of IL-6 and IL-8. CSF and serum samples were obtained on admission and the levels of each cytokine were determined with enzyma-Linked immunoasabent assay. (ELISA) Our patients, according to Hunt-Hess grade; GI (case 1, 4), GII (7, 9, 10), Gm (5, 6, 8), GTV (2,3), according to Fisher grade; GE (case 1, 4, 7, 9), Gm (case 2, 8, 10), GIV (case 3, 5, 6). We detected cerebral vasospasm from case 2, 3, 4, 5, 8. As result; We found the levels of IL-6 and IL-8 in CSF high after SAH. We detected the corelation between Hunt-Hess grade and fisher grade in the patients with SAH. As fisher classifications get higher, the Hunt-Hess classifications get higher, too. As Hunt-Hess and fisher classification get higher it can be said that the possibility of occurrence of vasospasm can be high. We considered that especially IL-6 could play an important role in vasospasm after SAH. KEY WORDS: Cytokine, Subarachnoid hemorrahage, Vasospasm. vu