Aneurysmal Subarachnoid Hemorrhage: Do Changes in Inflammatory Markers Precede or Succeed Symptomatic Vasospasm?

Societies grade I and II; Hunt and Hess grades I-III) presenting within 48 hours of ictus, who underwent clipping/coiling were included.Patients presenting with established clinical vasospasm at admission were excluded.Fisher grading as on index computed tomography (CT) was used for radiological grading of aSAH.After analyzing clinical and radiological data, patients were treated as per the departmental protocol.The decision of clipping/coiling was taken based on the location, characteristics of the aneurysm, and choice of patient/ family members.Patients were managed in the neurosurgical intensive care unit and were closely observed IntroductIonVasospasm is the key determinant of morbidity and mortality in aSAH patients who undergo successful management in the form of clipping/coiling.It is seen in about 70% of patients radiologically, and about 20-40% of patients are symptomatic because of vasospasm. 1,2The underlying pathophysiology of vasospasm is complex and multifactorial.Vasodilator mechanisms are impaired, and there is an overactivity of factors that are involved in vasoconstriction. 3Hence, measures aimed at understanding vasospasm remain a matter of intense research.Once fully established, the course of vasospasm is unfavorable and it becomes nonresponsive to usual management strategies.Early prediction and aggressive initial management make a substantial difference in the outcome.Various factors like age, gender, comorbidities, Fisher grade, location of the aneurysm, and hematological and inflammatory markers have got the potential to predict the subsequent development of vasospasm.[6][7][8][9][10][11][12][13][14] One point of debate is the temporal course of events, that is, the development of vasospasm vis-à-vis levels of systemic inflammatory markers.We have tried to address this problem in the present study.