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. 2022 Jul 26:13:861625.
doi: 10.3389/fneur.2022.861625. eCollection 2022.

Longitudinal ventricular cerebrospinal fluid profile in patients with spontaneous subarachnoid hemorrhage

Anne Zinganell  1 , Gabriel Bsteh  2 , Franziska Di Pauli  1 , Verena Rass  1 , Raimund Helbok  1 , Janette Walde  3 , Florian Deisenhammer  1 , Harald Hegen  1
Affiliations

Longitudinal ventricular cerebrospinal fluid profile in patients with spontaneous subarachnoid hemorrhage

Anne Zinganell et al. Front Neurol. .

Abstract

Background: Spontaneous subarachnoid hemorrhage (SAH) is a severe neurological disease that frequently requires placement of external ventricular drainage (EVD). Cerebrospinal fluid (CSF) obtained via the drain is used to detect potential complications of SAH.

Objective: This study aimed to describe the longitudinal profile of routine CSF parameters in patients with SAH and to identify associations with neurological complications.

Methods: A total of thirty-three patients with spontaneous SAH who required an EVD and had at least three consecutive CSF samples collected over a period of more than 7 days were included in this study.

Results: A median of 6 longitudinally collected CSF samples per patient were available within 1-22 days after SAH onset. Overall, red blood cells (RBC) steadily decreased over time, whereas white blood cells (WBC) and total protein (TP) increased until days 6 and 13, respectively, and decreased thereafter. The estimated decay rates of RBC, WBC, and TP were 28, 22, and 6% per day. Distinct CSF patterns over time were linked to known complications after SAH. Patients with rebleeding showed increased RBC, TP, and phagocytosing cells compared to patients without re-bleeding. For ventriculitis, an elevated cell index with a higher proportion of granulocytes was characteristic. CSF of patients with delayed cerebral ischemia showed increased RBC and WBC compared to patients without DCI. Early CSF WBC and cell index were predictive for the occurrence of DCI and ventriculitis later during the disease course. The amount of daily CSF drainage via EVD had no impact on routine CSF parameters.

Conclusion: Longitudinal CSF characteristics are associated with SAH-related complications.

Keywords: cerebrospinal fluid; cytology; longitudinal; red blood cell; subarachnoid hemorrhage; total protein; ventricular; white blood cell.

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Conflict of interest statement

Author AZ has participated in meetings sponsored by, received speaking honoraria or travel funding from Biogen, Merck, Sanofi-Genzyme, and Teva. GB has participated in meetings sponsored by, received speaker honoraria or travel funding from Biogen, Celgene-BMS, Lilly, Merck, Novartis, Sanofi-Genzyme, and Teva and received honoraria for consulting Biogen, Celgene-BMS, Merck, Novartis, Roche, Sanofi-Genzyme, and Teva. FDP has participated in meetings sponsored by, received honoraria (lectures, advisory boards, consultations) or travel funding from Almirall, Bayer, Biogen, Celgene-BMS, Merck, Novartis, Sanofi-Genzyme, Sandoz, Roche, and Teva. Her institution has received research grants from Roche. FD has participated in meetings sponsored by or received honoraria for acting as an advisor/speaker for Alexion, Almirall, Biogen, Celgene, Genzyme-Sanofi, Merck, Novartis Pharma, Roche, and Teva. His institution has received research grants from Biogen and Genzyme Sanofi. He is section editor of the MSARD Journal (Multiple Sclerosis and Related Disorders). HH has participated in meetings sponsored by, received speaker honoraria or travel funding from Bayer, Biogen, Celgene, Merck, Novartis, Sanofi-Genzyme, Siemens, Teva, and received honoraria for acting as consultant for Biogen, Celgene, Novartis and Teva. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Quantitation of CSF white blood cell subpopulations. CSF, cerebrospinal fluid; Q, quadrant; VF, visual field.
Figure 2
Figure 2
Longitudinal profile of CSF parameters in patients with SAH. Boxplots show (A) RBC, (B) WBC, (C) CSF total protein, (D) cell index, (E) granulocytes, (F) lymphocytes, (G) monocytes/ macrophages, and (H) erythrophages/ siderophages at six-time points after the onset of SAH (i.e., after median 3, 6, 10, 13, 17, and 20.5 days). CSF, cerebrospinal fluid; RBC, red blood cells; SAH, subarachnoid hemorrhage; WBC, white blood cells.
Figure 3
Figure 3
Decay rates of CSF RBC, WBC, and total protein in patients with SAH. Decay rates of (A) RBC, (B) WBC, and (C) total protein in ventricular CSF of patients with SAH are shown. Decay rates were adjusted for the amount of CSF discarded via the ventricular drain. CSF, cerebrospinal fluid; RBC, red blood cell count; SAH, subarachnoid hemorrhage; WBC, white blood cell count.
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References

    1. Lawton MT, Vates GE. Subarachnoid hemorrhage. N Engl J Med. (2017) 377:257–66. 10.1056/NEJMcp1605827 - DOI - PubMed
    1. Williams TA, Leslie GD, Dobb GJ, Roberts B, van Heerden PV. Decrease in proven ventriculitis by reducing the frequency of cerebrospinal fluid sampling from extraventricular drains. J Neurosurg. (2011) 115:1040–6. 10.3171/2011.6.JNS11167 - DOI - PubMed
    1. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. (2002) 51:170–81; discussion 81–2. 10.1097/00006123-200207000-00024 - DOI - PubMed
    1. Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Scheld WM, et al. . 2017 infectious diseases society of America's clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. (2017) 64:e34–65. 10.1093/cid/ciw861 - DOI - PMC - PubMed
    1. Macdonald RL. Delayed neurological deterioration after subarachnoid hemorrhage. Nat Rev Neurol. (2014) 10:44–58. 10.1038/nrneurol.2013.246 - DOI - PubMed

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