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Cerebrospinal Fluid Apolipoprotein E, Calcium and Cerebral Vasospasm after Subarachnoid Hemorrhage

School of Nursing, University of Pittsburgh, Pennsylvania, salexand{at}pitt.edu

Mary E. Kerr, RN, PhD

National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland

Jeffrey Balzer, PhD

Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Michael Horowitz, MD

Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Amin Kassam, MD

Department of Neurologic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Yookyung Kim, PhD

School of Nursing, University of Pittsburgh, Pennsylvania

Leslie Hoffman, RN, PhD

School of Nursing, University of Pittsburgh, Pennsylvania

Yvette P. Conley, PhD

School of Nursing, University of Pittsburgh, Pennsylvania

Intracellular calcium (Ca ⁺⁺) regulation of cerebral vessels is impaired after subarachnoid hemorrhage (SAH), making secondary pathways, such as that involving apolipoprotein E, potentially more influential. To evaluate cerebrospinal fluid (CSF) apolipoprotein E and Ca⁺⁺ levels as biomarkers of cerebral vasospasm, we examined changes in levels over time and apolipoprotein E (APOE) 4 allele presence after SAH in individuals with and without vasospasm. We hypothesized that individuals with low apolipoprotein E levels, increased Ca⁺⁺ levels and/or at least one copy of the APOE 4 allele would have vasospasm. Daily samples from 50 participants, aged 18—75, with SAH were used to quantify apolipoprotein E and Ca⁺⁺ levels. Vasospasm was verified using cerebral angiogram and/or elevated transcranial Dopplers in combination with clinical neurologic deterioration. Overall apolipoprotein E levels were higher in individuals with the APOE 4 allele (p = .02) or angiographic vasospasm (p = .01), but there were no differences between individuals with and without symptomatic vasospasm. There were no significant changes in apolipoprotein E levels over time. Individuals with the 4 allele had lower Ca ⁺⁺ levels (p = .02) with trends suggesting a different pattern of change over time (p = .07). CSF Ca⁺⁺ levels were lower in individuals with symptomatic vasospasm (p < .01). Change in apolipoprotein E and Ca ⁺⁺ levels (p = .006) correlated over time regardless of genotype or vasospasm status. These findings suggest that apolipoprotein E and Ca ⁺⁺ may be interacting after SAH, but this interaction does not appear to influence vasospasm.

Key Words: subarachnoid hemorrhage • cerebral vasospasm • apolipoprotein E • calcium • cerebrospinal fluid

Biological Research For Nursing, Vol. 10, No. 2, 102-112 (2008)
DOI: 10.1177/1099800408321722


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