Resarch of the effects of Myelin Basic Protein (MBP) and Ischemia Modified Albumin (IMA) levels in blood and cerebrospinal fluid on vasospasm, clinical progress and outcome in patients with non-traumatic subarachnoid hemorrhage

Objective: Non-traumatic subarachnoid hemorrhage still constitutes a major problem today, and its complications include hydrocephalus, risk of rebleeding and vasospasm. Imaging methods, cerebrospinal fluid (CSF) pressure measurements and physical examination are important for the prognosis of the disease. Ischemia modified albumin (IMA) may increase in the blood due to the decrease in blood flow in cerebral ischemia and the increase in oxidative stress occurring during reperfusion and is a sensitive biochemical marker for cerebral ischemia. Myelin basic protein (MBP) plays an important role in nerve and nervous system myelinization. MBP is associated with damage and recovery of white matter in brain injury. Radiologically, the Modified Fisher Scale, as a clinical evaluation, the Glasgow Coma Scale (GCS), WFNS (World Federation of Neurosurgical Societies) Rating Scale, the Hunt-Hess Rating Scale and the Glasgow Outcome Scale (GOS) are important markers in evaluating the severity of the disease in patients with non-traumatic subarachnoid hemorrhage. In this study, it was aimed to examine the MBP and IMA values in blood and CSF at certain time intervals in patients with non-traumatic subarachnoid hemorrhage, and to investigate their relationship with the patient's clinic and discharge course, along with neurological examination and radiological criteria. Materials and methods: Blood and CSF samples were taken from patients who were diagnosed with non-traumatic subarachnoid hemorrhage and whose consent was obtained, who applied to KTU Faculty of Medicine Farabi Hospital, on the first, fifth and tenth days of their admission to the hospital. Myelin Basic Protein (MBP) and Ischemia Modified Albumin (IMA) were measured using the ELISA method in serum and Cerebrospinal Fluid (CSF) samples taken from the patients. The Modified Fisher Scale score of patients diagnosed with non-traumatic subarachnoid hemorrhage was checked on the first day they were admitted to the hospital. The patients' scores on the first, fifth and tenth days in the hospital were evaluated using the Glasgow Coma Scale (GCS), WFNS (World Federation of Neurosurgical Societies) Rating Scale and Hunt-Hess Rating Scale. Patients were evaluated with the Glasgow Outcome Scale at discharge. By looking at the serum and cerebrospinal fluid values of Myelin Basic Protein (MBP) and Ischemia Modified Albumin (IMA) in patients with non-traumatic subarachnoid hemorrhage, their relationship with the patient's clinical course, vasospasm and discharge course, along with neurological examination and radiological criteria, was investigated. Results: A total of 20 patients, 7 female and 13 male, diagnosed with non-traumatic SAH were included in the study. The average age of the patients is 53.55. 13 patients had hypertension. The increase in serum IMA and CSF IMA values in non-traumatic SAH patients with a history of hypertension was found to be statistically significant with the patient's M. Fisher Scale grade at a significance level of p<0.05. Considering the first, fifth and tenth days, it was observed that the increase in CSF IMA value positively affected the Hunt-Hess Rating Scale score at a 5% significance level. It was observed that the increase in CSF IMA values on the tenth day decreased the GOS score statistically significantly at a level of 5%. Conclusion: Considering the first, fifth and tenth days, evaluation of CSF IMA levels together with HHS showed that it may be important in terms of clinical follow-up of the patient and monitoring of vasospasm. It was concluded that CSF IMA levels measured on the 10th day in non-traumatic SAH patients could be a candidate biochemical marker regarding the outcome and vasospasm of the patients. Additionally, a significant correlation was found between the extent of bleeding on brain CT images of non-traumatic SAH patients with hypertension and serum IMA and CSF IMA levels.