CHANGES OF ENDOTHELIN CONCENTRATION IN CEREBROSPINAL-FLUID AND PLASMA OF PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE

To investigate the clinical significance of endothelin (ET), a potent vasoconstrictor peptide, in subarachnoid hemorrhage (SAH) and SAH-related cerebral vasospasm, we measured the ET-like immunoreactivity (ET-LI) in plasma and cerebrospinal fluid (CSF) obtained serially from patients with SAH due to ruptured cerebral aneurysm who underwent aneurysmal surgery. The normal ET-LI levels in plasma and CSF (n = 24) were 12.4+/-2.0 (mean+/-s.d.) and 9.1+/-1.2 pg.ml(-1), respectively. Plasma ET-LT levels in patients with SAH before surgery (16.8+/-7.8 pg.ml(-1), n = 8) were higher than the normal values (P< 0.05), and became further elevated after surgery (22.5+/-9.4 pg ml(-1)). ET-LI levels in plasma and CSF one day after surgery were 18.7+/-5.5 and 18.4+/-6.8 pg ml(-1) (P< 0.01 vs. normal values), respectively and declined thereafter. The plasma and CSF ET-LI levels in patients who showed symptomatic vasospasm became concomitantly elevated again. These results suggest that ET is involved in SAH-related vasospasm and raise the possibility that surgical stress influences the vasospasm.