Prostaglandins and vasoactive amines in cerebral vasospasm after aneurysmal subarachnoid hemorrhage.

Five consecutively admitted patients with aneurysmal subarachnoid hemorrhage were treated with an indwelling lumbar spinal catheter. Daily samples of cerebrospinal fluid were analyzed for erythrocyte, protein, glucose, dopamine, epinephrine, serotonin, 5-hydroxyindoleacetic acid, tryptophan, histamine, thromboxane, 6-ketoprostaglandin F1 alpha, prostaglandin E, and prostaglandin F2 alpha concentrations. The patients' neurologic grade on admission, hospital course, presence of vasospasm, level of consciousness, computed tomographic and angiographic findings, and outcome were compared with the concentrations of the above substances in the cerebrospinal fluid. All patients had elevated concentrations of serotonin, with the highest levels found early in the hospital course of the patients who developed vasospasm. Tryptophan content increased markedly in association with clinical and angiographic vasospasm. Concentrations of prostaglandin F2 alpha correlated highly with development of and fluctuations in clinical vasospasm, with angiographic findings, with neurologic grade on admission, and with outcome. Our results suggest that prostaglandin F2 alpha may be involved in delayed clinical vasospasm in patients with subarachnoid hemorrhage.