Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May 16;24(10):8856.
doi: 10.3390/ijms24108856.

Immunological Profile of Vasospasm after Subarachnoid Hemorrhage

Michele Romoli  1 , Fabrizio Giammello  2 , Maria Giulia Mosconi  3 , Antonio De Mase  4 , Giovanna De Marco  5 , Anna Digiovanni  6 , Antonio Ciacciarelli  7 , Raffaele Ornello  8 , Benedetta Storti  9 ; IAY (Italian Stroke Association—Young Section)
Affiliations
Review

Immunological Profile of Vasospasm after Subarachnoid Hemorrhage

Michele Romoli et al. Int J Mol Sci. .

Abstract

Subarachnoid hemorrhage (SAH) carries high mortality and disability rates, which are substantially driven by complications. Early brain injury and vasospasm can happen after SAH and are crucial events to prevent and treat to improve prognosis. In recent decades, immunological mechanisms have been implicated in SAH complications, with both innate and adaptive immunity involved in mechanisms of damage after SAH. The purpose of this review is to summarize the immunological profile of vasospasm, highlighting the potential implementation of biomarkers for its prediction and management. Overall, the kinetics of central nervous system (CNS) immune invasion and soluble factors' production critically differs between patients developing vasospasm compared to those not experiencing this complication. In particular, in people developing vasospasm, a neutrophil increase develops in the first minutes to days and pairs with a mild depletion of CD45+ lymphocytes. Cytokine production is boosted early on after SAH, and a steep increase in interleukin-6, metalloproteinase-9 and vascular endothelial growth factor (VEGF) anticipates the development of vasospasm after SAH. We also highlight the role of microglia and the potential influence of genetic polymorphism in the development of vasospasm and SAH-related complications.

Keywords: delayed ischemia; early brain injury; subarachnoid hemorrhage; vasospasm.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patterns of CSF cellularity in SAH cases without vasospasm (A) and in people developing vasospasm after SAH (B).
Figure 2
Figure 2
Patterns of IL-6, VEGF and MMP-9 variations after SAH in people with vs. without vasospasm.
See this image and copyright information in PMC

References

    1. Macdonald R.L. Delayed Neurological Deterioration after Subarachnoid Haemorrhage. Nat. Rev. Neurol. 2014;10:44–58. doi: 10.1038/nrneurol.2013.246. - DOI - PubMed
    1. Connolly E.S., Rabinstein A.A., Carhuapoma J.R., Derdeyn C.P., Dion J., Higashida R.T., Hoh B.L., Kirkness C.J., Naidech A.M., Ogilvy C.S., et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–1737. doi: 10.1161/STR.0b013e3182587839. - DOI - PubMed
    1. Lovelock C.E., Rinkel G.J.E., Rothwell P.M. Time Trends in Outcome of Subarachnoid Hemorrhage: Population-Based Study and Systematic Review. Neurology. 2010;74:1494–1501. doi: 10.1212/WNL.0b013e3181dd42b3. - DOI - PMC - PubMed
    1. Worthington J.M., Goumas C., Jalaludin B., Gattellari M. Decreasing Risk of Fatal Subarachnoid Hemorrhage and Other Epidemiological Trends in the Era of Coiling Implementation in Australia. Front. Neurol. 2017;8:424. doi: 10.3389/fneur.2017.00424. - DOI - PMC - PubMed
    1. Pickard J.D., Murray G.D., Illingworth R., Shaw M.D.M., Teasdale G.M., Foy P.M., Humphreys P.R.D., Lang D.A., Nelson R., Richards P., et al. Effect of Oral Nimodipine on Cerebral Infarction and Outcome after Subarachnoid Haemorrhage: British Aneurysm Nimodipine Trial. Br. Med. J. 1989;298:636–642. doi: 10.1136/bmj.298.6674.636. - DOI - PMC - PubMed

MeSH terms

Substances