gms | German Medical Science

Objective: Spontaneous intracerebral hemorrhage (ICH) is the most severe kind of stroke. Beside the primary brain injury by mass effect, secondary brain injury induced by several factors like inflammation or oxidative stress(OS) determines patients’ outcome. An imbalance of oxidative and antioxidative processes results in OS. The aim of this study was to analyze the impact of OS on functional outcome of ICH patients.

Methods: 19 consecutive patients receiving an external ventricular drain with an ICH>30ml were included (7 females, 12 males, 64.05±10.99 years). 29 patients (15 females, 14 males, 57.52±15.28 years) with diverse pathologies not associated with oxidative stress, served as controls. Blood and CSF samples were obtained for assessment of OS markers (superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione-sulfhydryl (GSH), total antioxidant status (TAS) and malondialdehyde (MDA)). The values were analyzed by colorimetry, HPLC or ELISA. Clinical and outcome data were evaluated by modified Rankin scale (mRS) at 6 weeks and 6 months and neurocognition (assessed by MOCA) was correlated to the OS markers and ICH volumes.

Results: Mean ICH volume was 63.3±57.4cm3. Mean TAS differed significantly in serum samples of patients (80.3±20.43mmol/l, p=0.005) and controls (40.0±31.4mmol/l, p=0.005) at day 1. At the same time point, free (61.34±30.60mg/l) and total (69.57±25.82mg/l) GSH levels were significant higher in controls compared to ICH group (42.86±8.15mg/l; 55.5±7.59mg/l; p<0.0001). The mean total GPx concentration was significantly reduced after ICH (54.04±28.7mg/l compared to 69.6±25.8mg/l; p=0.03). CSF TAS levels were reduced significantly after ICH (178.4±20.8) compared to controls (221.0±87.4mmol/l; p=0.001). While TAS was higher in serum, it was reduced in CSF after ICH. ICH volume and mean TAS level in CSF (p=0.2) and in serum (p=0.039) correlated significantly. In CSF MDA (p=0.01) and SOD (p=0.03) showed a significant correlation to the volume of ICH.Decreased mean GPX in serum was associated with a higher mRS at week 6 (p=0.04). In CSF SOD (p=0,04) and reduced mean MDA levels correlated significantly with a higher mRS at 6 months (p=0.05).

Conclusion: In this study we found a clear association of ICH with a reduced antioxidative capacity in CSF and serum. Larger ICH volume showed higher OS levels, while latter correlated significantly with an unfavorable outcome. This might be one key factor in the pathophysiologic cascade of secondary brain injury.