CSF smooth-muscle constrictor activity associated with cerebral vasospasm and mortality in SAH patients

Cerebrospinal fluid (CSF) was collected preoperatively (by lumbar puncture) or perioperatively (by lumbar or ventricular drain) from 32 patients with subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms. Samples were also obtained from six control patients without evidence of subarachnoid blood. Smooth-muscle constrictor activity in the CSF was measured by bioassay using the isolated rat stomach fundus preparation. Concentrations of unidentified smooth-muscle constrictor substances were considerably greater in CSF from a group of seven patients with evidence of severe angiographic vasospasm and/or delayed ischemic deficits who died (73.8 +/- 39.7 nmol/liter prostaglandin E2 (PGE2) equivalents), as compared to 25 other SAH patients who survived (6.5 +/- 1.4 nmol/liter PGE2 equivalents), and six control patients (1.17 +/- 0.34 nmol/liter PGE2 equivalents). The data suggest that there is a relationship between smooth-muscle constrictor substances in the CSF after SAH and both the degree of angiographic vasospasm and the outcome. It is possible that this relationship might be exploited clinically.