Immune complexes and complement activation following rupture of intracranial saccular aneurysms

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✓ Circulating immune complexes (CIC) and complement activation (plasma C3d levels) were monitored during a 2-week period in patients with ruptured cerebral aneurysms and also in patients with cerebral hematoma unrelated to saccular aneurysms. Thirteen of 18 aneurysm patients were found to have CIC on admission as compared to three of 21 healthy blood donors (p < 0.001). The presence of CIC in aneurysm patients was associated with a poor prognosis. Eight of nine patients who developed angiographic vasospasm had CIC on admission compared with one of four without vasospasm. Patients with vasospasm showed a twofold increase in plasma C3d levels at the time when the spasm occurred, whereas no significant changes in the C3d concentration could be demonstrated in aneurysm patients without spasm or in patients with hematoma unrelated to aneurysm rupture. These findings suggest that immunological processes involving complement-activating immune complexes are involved in the pathogenesis of cerebral vasospasm following rupture of saccular aneurysms.

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Address reprint requests to: John R. Østergaard, M.D., Department of Neurosurgery GS, Aarhus Kommunehospital, DK-8000 Aarhus C, Denmark.

© AANS, except where prohibited by US copyright law.

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Figures

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    Plasma levels of complement C3d (mean ± standard error of the mean (SEM)) in nine aneurysm patients with vasospasm (filled circles) and in five aneurysm patients without spasm (open circles). The shaded area represents mean levels ± 2 SEM of C3d in 21 age- and sex-matched blood donors. SAH = subarachnoid hemorrhage.

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    Relationship between circulating immune complexes (CIC) on admission and C3d levels in the 2nd week following subarachnoid hemorrhage ( C3d = mean value for Days 7, 10, 14), and the increase in C3d levels (Δ C3d = mean value for Days 7, 10, and 14 minus mean value for Days 1, 2, and 3). The difference was statistically significant at p < 0.05 and p < 0.01, respectively, according to the Wilcoxon-Mann-Whitney test.

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    Relationship between the computerized tomography (CT) score on admission and C3d levels in the 2nd week following aneurysm rupture. No significant correlation was found. Filled circles indicate aneurysm patients with spasm; open circles indicate aneurysm patients without spasm. CIC = circulating immune complexes.

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