Summary
CSF eicosanoid levels are raised following subarachnoid haemorrhage but not sufficiently to be vasoactive per se within the cerebral circulation. Rebleeding and intraventricular haemorrhage are two factors associated with a worse outcome after aneurysmal SAH. We have examined the effects of these two factors on the CSF levels of TXB2 (TXA2 metabolite), PG 6-keto F1α (prostacyclin metabolite), PGF2α and PGE2 in 44 patients following subarachnoid haemorrhage. In 15 patients who had received no non-steroidal antiinflammatory agent or dexamethasone, intraventricular haemorrhage increased the median levels of all four eicosanoids in ventricular CSF by 2.1–5.1-fold. In 4 patients who rebled, the CSF median levels of all four eicosanoids were raised up to 250-fold over the normal range. These concentrations are just sufficient to have cerebrovascular and neuromodulatory effects.
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References
Black P (1986) Hydrocephalus and vasospasm after subarachnoid haemorrhage from ruptured intracranial aneurysms. Neurosurgery 18: 12–16
Boullin DJ, Bunting S, Blaso WP, Hunt TM, Moncada S (1979) Responses of human and baboon arteries to prostaglandin endoperoxides and biologically generated and synthetic prostacyclin: their relevance to cerebral arterial spasm in man. Br J Clin Pharmacol 7: 139–147
Chan RC, Durity FA, Thompson GB, Nugent RA, Kendall M (1984) The role of the prostacyclin-thromboxane system in cerebral vasospasm following induced subarachnoid haemorrhage in the rabbit. J Neurosurg 61: 1120–1128
Chehrazi BB, Giri S, Joy RM (1989) Prostaglandins and vasoactive amines in cerebral vasospasm after aneurysmal subarachnoid haemorrhage. Stroke 20: 217–224
Clark FL, White RP (1989) Endothelium and cerebral vasospasm. Letter. J Neurosurg 70: 657–658
Chyatte D, Fode NC, Nichols DA, Sundt TM (1987) Preliminary report: effects of high dose methylprednisolone on delayed cerebral ischaemia in patients at high risk for vasospasm after aneurysmal subarachnoid haemorrhage. Neurosurgery 21: 157–160
Cranston WI, Duff GW, Hellon RF, Mitchell D, Townsend Y (1976) Evidence that brain prostaglandin is not essential in fever. J Physiol 259: 239–249
Fukumori T, Tani E, Maeda Y, Sukenaga A (1983) Effects of prostacyclin and indomethacin on experimental cerebral vasospasm. J Neurosurg 59: 829–834
Gaetani P, Rodriguez y Baena R, Marzatico F (1993) Role of prostaglandins in delayed cerebral ischaemia after subarachnoid haemorrhage. Letter. Neurosurgery 32: 329
Hedqvist P, Wennmalm A (1971) Comparison of the effects of prostaglandin E1, E2, and F2α on the sympathetically stimulated rabbit heart. Acta Physiol Scand 83: 156–162
Maeda Y, Tani E, Miyamoto T (1981) Prostaglandin metabolism in experimental cerebral vasospasm. J Neurosurg 55: 779–785
Mendelow AD, Stockdill G, Steers AJ, Hayes J, Gillingham FJ (1982) Double-blind trial of aspirin in patients receiving tranexamic acid for SAH. Acta Neurochir (Wien) 62: 195–202
Mohr G, Ferguson G, Khar Met al (1983) Intraventricular haemorrhage from ruptured aneurysm. Retrospective analysis of 91 cases. J Neurosurg 58: 482–487
Nosko M, Schulz R, Weir B, Cook DA, Grace M (1988) Effects of vasospasm on levels of prostacyclin and thromboxane A2 in cerebral arteries of the monkey. Neurosurgery 22: 45–50
Okamoto S, Handa H, Toda N (1984) Role of intrinsic arachidonate metabolites in the vascular action of erythrocyte breakdown products. Stroke 15: 60–64
O'Neill P, Watton S, Foy PM, Shaw MDM (1991) Role of prostaglandins in delayed cerebral ischaemia after subarachnoid haemorrhage. Neurosurgery 30: 17–22
Pickard JD, Mackenzie ET (1973) Inhibition of prostaglandin synthesis and the response of baboon cerebral circulation to carbon dioxide. Nature (New Biol) 245: 187–188
Pickard JD, Walker V, Perry S, Smythe PJ, Eastwood S, Hunt R (1984) Arterial eicosanoid production following chronic exposure to a periarterial haematoma. J Neurol Neurosurg Psychiatry 47: 661–667
Pickard JD, Walker V, Vile J, Perry S, Smythe PJ, Hunt R (1987) Oral Nimodipine reduces prostaglandin and thromboxane production by arteries chronically exposed to a periarterial haematoma and the antifibrinolytic agent tranexamic acid. J Neurol Neurosurg Psychiatry 50: 727–731
Pickard JD, Walker V, Newton H, Smythe PJ, Perry S (1990) Effect of hydrocephalus on prostaglandins and thromboxane B2 in ventricular cerebrospinal fluid. Neurosurgery 27: 943–945
Rodriguez y Baena R, Gaetani P, Foko G, Branzoli U, Paoletti P (1985) Cisternal and lumbar CSF concentration of arachidonate metabolites in vasospasm following subarachnoid haemorrhage from ruptured aneurysm. Surg Neurol 24: 428–432
Rogriguez y Baena R, Gaetami R, Grignani G, Pacchiarini L (1987) Effect of nimodipine on arachidonic acid metabolites after subarachnoid haemorrhage. Acta Neurol Scand 76: 267–271
Sasaki T, Marota S, Wakai S, Asano T, Sano K (1981) Evaluation of prostaglandin biosynthesis activity in canine basilar artery following subarachnoid injection of blood. J Neurosurg 55: 771–778
Seifert V, Stolke D, Kaever V, Dietz H (1987) Arachidonic acid metabolism following aneurysm rupture. Surg Neurol 27: 243–252
Suzuki S, Sobata E, Iwabuchi T (1981) Prevention of cerebral ischaemic symptoms in cerebral vasospasm with trapidil, an antagonist and selective synthesis inhibitor of thromboxane A2. Neurosurgery 9: 679–685
Uski TK, Andersson KE (1984) Effects of prostanoids on isolated feline cerebral arteries. Acta Physiol Scand 120: 131–136
Vinge E, Brandt L, Ljunggren B, Andersson KE (1988) Thromboxane B2 levels in serum during continuous administration of nimodipine to patients with aneurysmal subarachnoid haemorrhage. Stroke 19: 644–647
Walker V, Pickard JD (1985) Prostaglandins, thromboxane, leukotrienes, and the cerebral circulation in health and disease. Adv Tech Stand Neurosurg 12: 3–90
Walker V, Pickard JD, Smythe P, Eastwood S, Perry S (1983) Effects of subarachnoid haemorrhage on intracranial prostaglandins. J Neurol Neurosurg Psychiatry 46: 119–125
White RP, Hagen AA (1982) Cerebrovascular actions of prostaglandins. Pharmacol Ther 18: 303–331
White RP, Robertson JT (1983) Comparison of piroxicam, meclofenamate, ibuprofen, aspirin, and prostacyclin efficacy in a chronic model of cerebral vasospasm. Neurosurgery 12: 40–46
Wolfe LS, Coceani F (1979) The role of prostaglandins in the central nervous system. Ann Rev Physiol 41: 669–684
Zuccarello M, March JT, Schmitt G, Woodward J, Anderson DK (1989) Effect of the 21-aminosteroid U-74006F on cerebral vasospasm following subarachnoid haemorrhage. J Neurosurg 71: 98–104
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Pickard, J.D., Walker, V., Brandt, L. et al. Effect of intraventricular haemorrhage and rebleeding following subarachnoid haemorrhage on CSF eicosanoids. Acta neurochir 129, 152–157 (1994). https://doi.org/10.1007/BF01406495
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DOI: https://doi.org/10.1007/BF01406495