Identification of Novel Molecular Markers for Vasospasm

Cerebral vasospasm is a recognized and poorly understood complication for many patients who
have aneurysmal subarachnoid hemorrhage. Constriction of the cerebral arterial vasculature
occurs as free subarachnoid blood under high pressure comes into contact with the surfaces
of vessels, particularly in the basal cisterns. However, the exact pathophysiology of
vasospasm is unknown. Morbidity and mortality rates for vasospasm are high despite
improvements in management. Excluding the initial hemorrhage, cerebral vasospasm is
recognized as the main cause of substantial disability and death. Cerebral vasospasm kills
7% of patients, and causes severe deficit in another 7%. Cerebral vasospasm almost never
occurs before day 3, has maximal incidence at days 6-8, and rarely occurs after day 17. The
disorder is clinically characterized by confusion or decreased consciousness with focal
neurological deficit.

Experimental evidence suggests that red blood cell hemolysis and subsequent release of
oxygen, hemoglobin, reactive oxygen species, and other as yet undescribed mediators are
necessary for the development of vasospasm. The goal of this study is to use modern tools of
genomics to identify novel molecular markers for the process of vasospasm by studying the
release of micro ribonucleic acids (RNA) that are secreted into the cerebrospinal fluid
following the initiation of vasospastic cascades. Micro RNA's have recently been identified
as important regulators of many cellular processes including cell cycle progression,
proliferation, tumor suppressors, oncogenes, and regulators of metabolic pathways. The
researchers propose to study the levels of annotated micro RNA's in the cerebrospinal fluid
(CSF) of patients who present with subarachnoid hemorrhage from presentation through the
hospital stay. The researchers will correlate the level of these micro RNA's with patient
clinical presentation, including transcranial Doppler measurements, Glasgow Coma Scale
score, vital signs, and angiographic studies. It is well established that the process of
vasospasm occurs over the course of many days. Long before vasospasm becomes clinically
evident, cellular processes causing spasm are in action and the researchers hope to identify
micro RNA mediators of these processes using high throughput screening methods.

Inclusion Criteria:

- Adult patients with aneurysmal subarachnoid hemorrhage within 24-hours of bleed.

- Receive either open vascular clipping or endovascular coiling.

Exclusion Criteria:

- Patients under 18 years of age.

- Patients arriving at the hospital >24-hours post-hemorrhage.

- Patients who are not candidates for further care.