Substantially elevated serum glutamate and CSF GOT-1 levels associated with cerebral ischemia and poor neurological outcomes, in SAH patients

Abstract

Abstract Early brain injury and cerebral vasospasm during the 14 days after the subarachnoid hemorrhage (SAH) are considered the main causes of poor outcome. The primary injury induces a cascade of events, including increased intracranial pressure (ICP), cerebral vasospasm and ischemia, glutamate excitotoxicity, and neuronal cell death. The objective of this study was to monitor the time course of glutamate, aspartate, and glutamate-associated enzymes such as glutamate-oxaloacetate transaminase (GOT1), glutamate-pyruvate transaminase (GPT) in cerebrospinal fluid (CSF) and serum, during the first weeks after SAH, and to assess their prognostic value. A total of 74 participants participated in this study: 45 participants with SAH and 29 controls. Serum and CSF were sampled up to 14 days after SAH. The clinical and neurological status of SAH participants were assessed at hospitalization, at discharge from the hospital, and 3 months after SAH.Our results demonstrated that serum and CSF glutamate levels were consistently elevated after SAH. Furthermore, high serum glutamate levels displayed a positive correlation with the worst neurological status at admission, and with the cerebral ischemia and poor neurological outcome. CSF GOT1 was elevated in SAH participants and positively correlated with intracranial hypertension, with cerebral ischemia and poor neurological outcome post-SAH.