Evidence map›Paper›PMID 41239164›Full record

Observational studyNeurocritical care2026

Association of Serial Ventricular Routine Cerebrospinal Fluid Findings with Complications and Outcome in Aneurysmal Subarachnoid Hemorrhage: A Retrospective Observational Study.

Claudio Togni, Mina Pasqualini, Ignazio de Trizio, Francesca Casagrande, Federica Stretti, Emanuela Keller, Giovanna Brandi

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Claudio TogniDepartment of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Mina PasqualiniInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Ignazio de TrizioInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Francesca CasagrandeInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Federica StrettiInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Emanuela KellerInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Giovanna BrandiInstitute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland. giovanna.brandi@usz.ch.ORCID 0000-0002-6682-2424

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCerebrospinal fluid (CSF) inflammation is frequently seen in patients with aneurysmal subarachnoid hemorrhage (aSAH) requiring an external ventricular drain. Its role as a physiological response to the extravasation of blood, as a driver of delayed cerebral ischemia (DCI) and chronic hydrocephalus, or as a marker of ventriculostomy-related infection remains controversial. This study explored the associations between longitudinal routine CSF parameters and the development of DCI, shunt-dependent hydrocephalus, and functional neurological outcome in a large aSAH cohort.

methodsIn this retrospective study, 702 samples from 169 patients with aSAH with at least three serial ventricular CSF samples from an external ventricular drain within the first 14 days after aSAH were included. Routine CSF parameters-that is, leukocyte count (CC) and erythrocyte count (EC), CSF lactate (LCT), and CSF/plasma glucose ratio-were considered. For bivariate analysis, values and time points of peak CC, EC, LCT, and trough CSF/plasma glucose ratio, respectively, and mean values in the early, middle, and late phase after aSAH were considered. For the analysis of longitudinal CSF parameter dynamics, generalized linear mixed-effects modeling was applied. Patients were compared according to the development of DCI, shunt-dependent hydrocephalus, and dichotomized short-term and long-term functional neurological outcome.

resultsLongitudinal CC followed a nonlinear course over the first 14 days, with a peak around day 4 to day 8 after aSAH with a temporal relationship between peak CC and the occurrence of DCI. Higher initial EC with a more rapid decline was associated with favorable functional outcome, whereas persistently elevated LCT levels were seen in patients with unfavorable outcome. Patients with microbiologically confirmed ventriculostomy-related infection did not stand out significantly regarding CC absolute values or longitudinal dynamics.

conclusionsIntrathecal inflammation during the first 14 days after aSAH with a peak around day 7 seems to be a physiological response to the extravasation of blood into the CSF space. In patients with favorable outcome, EC decay was more rapid, indicating a more efficient clearance of blood from the subarachnoid space.

Indexed as

Brain IschemiaHydrocephalusSubarachnoid HemorrhageAdultAgedBlood GlucoseCerebrospinal Fluid ShuntsErythrocyte CountFemaleHumansLactic AcidLeukocyte CountMaleMiddle AgedRetrospective StudiesVentriculostomyBlood GlucoseLactic AcidCerebrospinal fluidDelayed cerebral ischemiaFunctional neurological outcomeHydrocephalusSubarachnoid hemorrhage

Identifiers

PMID41239164
PMCPMC13053543

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.