ENDOTHELIN CONCENTRATIONS IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE - CORRELATION WITH CEREBRAL VASOSPASM, DELAYED ISCHEMIC NEUROLOGICAL DEFICITS, AND VOLUME OF HEMATOMA

Plasma and cerebrospinal fluid (CSF) concentrations of endothelin (ET) -1, ET-3, and big ET-1 in patients with aneurysmal rupture were measur ed serially for 2 weeks after the onset of aneurysmal subarachnoid hem orrhage (SAH) and compared with levels of ETs in patients without SAH and the plasma concentrations of ETs in normal volunteers. Big ET-1 wa s the predominant peptide present in the CSF of SAH patients. The CSF concentrations of big ET-1, ET-1, and ET-3 were significantly higher i n older patients than in younger patients. In SAH patients with cerebr al vasospasm (CVS) documented by transcranial Doppler sonography and c linical signs, postoperative concentrations of ETs in the CSF remained at or were increased above levels measured before surgery. In SAH pat ients without CVS, the concentrations of ETs in the CSF decreased with time, whereas the time course of CVS coincided with the increase in c oncentrations of big ET-1 and ET-1. The temporal dependence of concent rations of big ET-1 and ET-1 in SAH patients with and without CVS were significantly different. The volume of hematoma in the basal cisterns as detected by computerized tomography was predictive of the concentr ations of ETs in the CSF. Plasma concentrations of ETs were not correl ated wtih CVS. The possible role of ETs in the pathogenesis of CVS ass ociated with SAH and the controversial data reported to date are discu ssed.