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Determinants of Central Sympathetic Activation in Spontaneous Primary Subarachnoid Hemorrhage

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Abstract

Background

Subarachnoid hemorrhage (SAH) has been associated with pronounced acute sympathetic activation. The purpose of this investigation is to identify demographic, clinical, radiological, and anatomical features of SAH that relate to sympathetic activation.

Methods

Observational study of consecutive Grades 3–5 SAH patients requiring ventriculostomy and undergoing endovascular aneurysmal obliteration. All patients underwent cerebrospinal fluid (CSF) sampling within 48 h of SAH onset, and samples were assayed for various catecholamine compounds and metabolites. Univariate analyses were performed to identify variables associated with catecholamine levels, and to correlate linearity among catecholamine compounds and metabolites. Variables demonstrating a possible association and variables of interest were entered into linear regression models to determine predictors of catecholamine elevations.

Results

Of the 102 patients, mean age was 58 years and 74% were female; 42% were Hunt–Hess (H/H) grade 4/5, 61% had a computed tomography (CT) score of 3/4, 57% had anterior cerebral or communicating artery (ACA/ACom) aneursysms, and 23% had aneurysms in the posterior circulation. In the univariate analysis, age, gender, H/H grade, CT score, and aneurysm location demonstrated various associations with catecholamine levels, and substantial positive correlations existed between the various catecholamine compounds and metabolites. Linear regression analyses revealed H/H grade to be an independent predictor of elevated CSF epinephrine (EPI), 3,4-dihydroxyphenylalanine (DOPA) and 3,4-dihydroxyphenyl acetic acid (DOPAC) levels, and of the norepinephrine/3,4-dihydroxyphenylglycol (NE/DHPG) ratio (p < 0.05 for all analyses). Female gender independently predicted increased dopamine (DA) and DOPAC levels (p < 0.05 for two analyses), as well as possibly DOPA levels (p < 0.1). Age, CT score and aneurysm location demonstrated only inconsistent associations and trends.

Conclusions

Central sympathetic activation relates to clinical severity and female gender. No definitive associations were found for age, hemorrhage amount, or aneurysm location.

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Acknowledgments

The authors express gratitude to the nurses of the neurological intensive care unit from the Jefferson Hospital of Neurosciences at Thomas Jefferson University Medical Center for their assistance in this project. This project represents a collaboration between the Neurocritical Care Division in the Department of Neurology at Thomas Jefferson Medical Center, and the Section on Neuroendocrinology of the Reproductive and Adult Endocrinology Program at the National Institutes of Health. This research study was supported in part by the Intramural Research Program of the NIH/NICHD.

Conflict of interest

The authors have no financial disclosures or conflicts of interest to announce.

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Authors and Affiliations

  1. Cerebrovascular & Neurocritical Care Division, Department of Neurology, Thomas Jefferson Medical Center, 900 Walnut Street, Suite 200, Philadelphia, PA, 19107, USA

    Michael Moussouttas

  2. Section on Medical Neuroendocrinology, Reproductive and Adult Endocrinology Program, National Institutes of Health, Bethesda, MD, USA

    Edwin W. Lai, Thanh T. Huynh & Karel Pacak

  3. Department of Neurology, Thomas Jefferson Medical Center, Philadelphia, PA, USA

    John Khoury & Keith Dombrowski

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  1. Michael Moussouttas
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  2. Edwin W. Lai
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Correspondence to Michael Moussouttas.

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Moussouttas, M., Lai, E.W., Khoury, J. et al. Determinants of Central Sympathetic Activation in Spontaneous Primary Subarachnoid Hemorrhage. Neurocrit Care 16, 381–388 (2012). https://doi.org/10.1007/s12028-012-9673-5

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