The goal of this observational study is to understand if angiographic cerebral vasospasm (CV) can be predicted by levels of nitric oxide (NO) consumption in patients with aneurysmal subarachnoid hemorrhage (SAH). To reach this goal, the investigators will compare NO consumption levels in SAH and non-SAH patients. NO consumption levels will be analyzed from samples of participants' cerebral spinal fluid (CSF).
After enrollment, the investigators will collect patients' demographics and most relevant clinical characteristics of the patients. For patients with SAH, the investigators will collect an-1 ml aliquot of CSF from the drainage circuit daily, (using a sterile procedure that involves a valve of the closed system circuit located distally to the patient, before the collection container), for a period of 15 days following SAH. The samples will be stored at -80 degrees. The investigators will perform daily Transcranial Doppler (TCD) monitoring to assess whether the patients have cerebral vasospasm. In case of suspected vasospasm, and in all comatose patients after 4 days from the bleeding, a CT angiography will be performed to define the angiographic CV. For the control group, discarded 1 ml-aliquot of CSF will be collected at the time of needle insertion for spinal anesthesia. At the end of the protocol, the study population will be divided in 3 groups: * patients with SAH and vasospasm * patients with SAH and no vasospasm * control group
Study Type
OBSERVATIONAL
Enrollment
40
Massachusetts General Hospital
Boston, Massachusetts, United States
RECRUITINGFondazione Policlinico Universitario Agostino Gemelli
Rome, Italy
RECRUITINGNitric oxide consumption
Measurement taken from cerebrospinal fluid using nitric oxide consumption analyzer
Time frame: Daily for 15 days following aneurysmal subarachnoid hemorrhage; for controls, once at initiation of spinal anesthesia
Occurrence of cerebral vasospasm in patients with subarachnoid hemorrhage
Transcranial Doppler monitoring will provide peak systolic velocities (PSVs) at the middle (MCA), anterior (ACA), and posterior (PCA) cerebral arteries. Suspected vasospasm will be defined as a mean flow velocity \>120 cm/s and a Lindegaard ratio (LR) ≥3. The LR will be obtained by dividing the mean flow velocities of the MCA by those of ipsilateral extracranial internal carotid artery. In case of suspected vasospasm, and in all comatose patients after 4 days from the bleeding, a CT angiography will be performed to define the angiographic CV.
Time frame: Daily for 15 days following aneurysmal subarachnoid hemorrhage
Nitric oxide metabolite levels
Measurement taken from cerebrospinal fluid
Time frame: Daily for 15 days following aneurysmal subarachnoid hemorrhage; for controls, once at initiation of spinal anesthesia
Free hemoglobin
Measurement taken from cerebrospinal fluid
Time frame: Daily for 15 days following aneurysmal subarachnoid hemorrhage; for controls, once at initiation of spinal anesthesia
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