• Fernando D Testai, Venkatesh Aiyagari, Maureen Hillmann, Sepideh Amin-Hanjani, Glyn Dawson, and Philip Gorelick.
• Department of Neurology of the University of Illinois at Chicago, 912 S Wood Street (MC-796), Chicago, IL 60612-7330, USA. testai@uic.edu
• Neurocrit Care. 2011 Dec 1;15(3):416-20.

BackgroundThe pathogenesis of vasospasm (VS) post aneurysmal subarachnoid hemorrhage (SAH) is multifactorial and not completely understood. The authors hypothesize that circulating antiangiogenic factors play an important role in brain injury post SAH and that elevated levels predict the occurrence of symptomatic vasospasm.MethodsIn this study the authors measured the serum and cerebrospinal fluid (CSF) levels of soluble endoglin (sEng) and soluble fms-like tyrosine kinase 1 (sFlt1) in controls and SAH patients within 48 h of the bleed. Patients were prospectively followed and subcategorized into those with (sVS) and without symptomatic vasospasm (no-sVS).ResultsCompared to healthy controls, SAH patients had higher CSF levels of sEng (0.037 vs. 0.251 ng/ml; P = 0.02) and sFlt1 (0.068 vs. 0.679 ng/ml; P = 0.001). In the subgroup analysis, sVS patients had higher CSF levels of sEng and sFlt1 than no-sVS patients (sEng: 0.380 vs. 0.159 ng/ml, P = 0.02; sFlt1: 1.277 vs. 0.343 ng/ml, P = 0.01). The serum levels of sEng and sFlt1 were not statistically different among the different groups.ConclusionsBased on these results the authors conclude that elevated CSF levels of sFlt1 and sEng herald the occurrence of symptomatic VS post SAH.

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