Identification of Novel Molecular Markers for Vasospasm
Identification of Novel Molecular Markers for Vasospasm
The purpose of the study is to identify novel genetic and protein markers for the process of
 cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
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.