Douglas MR et al. (2008) High CSF TGFβ levels after subarachnoid haemorrhage: association with chronic communicating hydrocephalus. J Neurol Neurosurg Psychiatry [doi:10.1136/jnnp.2008.155671]

Chronic communicating hydrocephalus (CCH) is a common complication of subarachnoid hemorrhage, and results from fibrosis in the subarachnoid space blocking the drainage of cerebrospinal fluid (CSF). Transforming growth factor (TGF)-β1 and TGF-β2 have been implicated in the development of CCH in rodent models; a UK study has now found that high TGF-β levels predict the development of CCH after subarachnoid hemorrhage in humans.

Douglas et al. measured TGF-β levels in CSF collected from twenty patients with acute hydrocephalus after subarachnoid hemorrhage, and compared these levels with those from seven patients with chronic nonhemorrhagic hydrocephalus. Posthemorrhagic patients had significantly higher levels of total and active TGF-β1 and TGF-β2 than did nonhemorrhagic patients. Total TGF-β levels peaked 1–5 days after hemorrhage, and remained elevated compared with control values at all subsequent time points. Comparison with the trend in albumin levels ruled out rebleeding as a cause of consistently elevated TGF-β levels. In total, 10 patients with subarachnoid hemorrhage went on to develop CCH, and these patients had significantly higher TGF-β1 and TGF-β2 levels over days 1–9 after hemorrhage than those who did not develop CCH.

The authors conclude that elevated TGF-β levels in the CSF after subarachnoid hemorrhage are potential predictors of CCH and may indicate a need for early therapeutic intervention.