Kolias, AG; (2007) Extracellular fluid astroglial markers of brain injury after subarachnoid haemorrhage. Doctoral thesis , UCL (University College London).

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Abstract

Inroduction: Despite the great strides that have been made during the modern era of cerebrovascular surgery, subarachnoid haemorrhage (SAH) remains a devastating illness. Approximately 12% of patients die before receiving medical attention, 40% of hospitalized patients die within one month after the event, and more than one third of those who survive have major neurological deficits and will be dependent on others for activities of daily living. The prognosis of patients surviving the initial ictus and reaching hospital care is mainly aggravated by a number of secondary insults (cerebral vasospasm, intracranial hypertension, rebleeding, seizures, hydrocephalus, ischaemia, hypoxia) which commonly complicate their in-hospital clinical course. Earlier detection of these insults would enable us to treat them in a more timely and aggressive manner biochemical markers could certainly contribute to this goal. Our hypothesis is that certain substances released into brain extracellular fluid (ECF) during the primary and secondary insults could correlate with or even precede clinical manifestations of secondary insults, and act as predictors of short and long-term outcome. We chose to focus on two astroglial proteins, namely S100B and glial fibrillary acidic protein (GFAP), as the astrocytes play a critical role in the regulation of brain homeostasis at the cellular level, and they are immediately activated after the initial ictus. Moreover, both proteins have shown some promising results when measured in serum, cerebrospinal fluid (CSF), and ECF.

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