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Axonal damage and outcome in subarachnoid haemorrhage

¹ Department of Neuroimmunology, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
² The Tavistock Intensive Care Unit, The National Hospital for Neurology and Neurosurgery
³ University Hospital Birmingham, Birmingham, UK
⁴ National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA

Correspondence to:
Correspondence to:
A Petzold
Department of Neuroimmunology, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; a.petzold{at}ion.ucl.ac.uk

Background: On the basis of preliminary evidence from patients with subarachnoid haemorrhage (SAH), axonal degeneration is thought to be an underestimated pathological feature.

Methods: A longitudinal study in 17 patients with aneurysmal SAH. Ventricular CSF was collected daily for up to 14 days. The neurofilament heavy chain^SMI35 (NfH^SMI35, a biomarker for axonal damage) was quantified using a standard ELISA (upper limit of normal 0.73 ng/ml). The primary outcome measure was the Glasgow Outcome Score (GOS) at 3 months.

Results: Of 148 samples from patients with SAH, pathologically high NfH levels in the CSF were found in 78 (52.7%) samples, compared with 20 (5%) of 416 samples from the reference population (p<0.0001). A pathological increase in NfH was observed in all patients with a bad outcome (GOS 1–3) compared with 8% of those with a good outcome (GOS 4–5, p<0.0001). This increase typically became significant 7 days after the haemorrhage (p<0.01). The result was confirmed by analysing the individual mean NfH concentrations in the CSF (3.45 v 0.37 ng/ml, p<0.01), and was reinforced by the inverse correlation of NfH in the CSF with the GOS (r = –0.65, p<0.01). Severity of injury was found to be correlated to NfH^SMI35 levels in the CSF (World Federation of Neurological Surgeons, r = 0.63, p<0.01 and Glasgow Coma Score, r = –0.61, p<0.01).

Conclusion: Patients with SAH thus have secondary axonal degeneration, which may adversely affect their outcome.

Abbreviations: GOS, Glasgow Outcome Score; NfH, neurofilament heavy chain; NfH^SMI35, antibody SMI35 used to measure protein NfH; NfL, neurofilament light chain; SAH, subarachnoid haemorrhage

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Unravelling the causes of cerebral damage in subarachnoid haemorrhage: might biomarkers help?

A A Rabinstein
J. Neurol. Neurosurg. Psychiatry 2006 77: 711. [Extract] [Full Text] [PDF]

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				A A Rabinstein Unravelling the causes of cerebral damage in subarachnoid haemorrhage: might biomarkers help? J. Neurol. Neurosurg. Psychiatry, June 1, 2006; 77(6): 711 - 711. [Full Text] [PDF]