J Korean Neurosurg Soc.  2013 Oct;54(4):289-295. 10.3340/jkns.2013.54.4.289.

Significance of C-Reactive Protein and Transcranial Doppler in Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

• Hwang SH
• Park YS
• Kwon JT
• Nam TK
• Hwang SN
• Kang H

• KMID: 1499333
• DOI: http://doi.org/10.3340/jkns.2013.54.4.289

Abstract

OBJECTIVE
Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH.
METHODS
A total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks.
RESULTS
Serum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD.
CONCLUSION
Patients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.

Keyword

Cerebral aneurysms; C-reactive protein; Subarachnoid hemorrhage; Vasospasm

MeSH Terms

Adult
Aneurysm*
Angiography, Digital Subtraction
C-Reactive Protein*
Demography
Humans
Intracranial Aneurysm
Middle Cerebral Artery
Neurologic Examination
Organothiophosphorus Compounds
Subarachnoid Hemorrhage*
Vasospasm, Intracranial*
C-Reactive Protein
Organothiophosphorus Compounds

Figure

• 

  Fig. 1 Schematic representation of C-reactive protein (CRP, mg/L) levels in serum with and without vasospasm.

• 

  Fig. 2 Schematic representation of mean transcranial Doppler (TCD, cm/sec) levels with and without vasospasm.

• 

  Fig. 3 Schematic representation of C-reactive protein (CRP, mg/L) levels according to the development of vasospasm in the postoperative infectious group (A) and in the non-infectious group (B). A : CRP levels are significantly higher in the group with infection on postoperative days 9 and 11. B : CRP levels are significantly higher in the group with vasospasm on the 3rd and 5th postoperative days.

• 

  Fig. 4 Receiver Operating Characteristic (ROC) curve of C-reactive protein (CRP) levels in serum on the 1st postoperative day (A) and mean transcranial Doppler (TCD) on the 3rd postoperative day (B). A : The area under the receiver-operating curves to predict vasospasm is 0.700 for CRP levels on the 1st postoperative day. B : The area under the receiver-operating curves to predict vasospasm is 0.822 for the mean TCD level on the 3rd postoperative day. AUC : area under the ROC curve.

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