Introduction: Hydrocephalus following aneurysmal-pattern subarachnoid hemorrhage (apSAH) often necessitates procedural intervention but pathophysiology of this process is incompletely understood. Loss of ependymal cilia, key for cerebrospinal fluid (CSF) flow, is associated with hydrocephalus. We hypothesized that apSAH patients requiring ventriculoperitoneal shunt (VPS) have increased exuded cilia in their CSF.

Methods: To test this hypothesis, we compared presence of DNAH5 (cilia marker) detected by ELISA (MyBioSource) in CSF from patients that presented with apSAH compared to controls undergoing elective craniotomy. We performed a prospective study of 40 patients' CSF, 20 apSAH and 20 controls. We collected multiple CSF samples from each apSAH patient's external ventricular drain during admission and a single CSF sample from each control during their elective craniotomy.

Results: Forty patients were enrolled, 20 in each group. The apSAH group consisted of 65% females (13/20). 75% (3/4) of the VPS placements were in male patients. The control group was 90% female (18/20). The mean age of all patients was not statistically different between the groups (58.0 years). On the initial sample collected in each apSAH patient, DNAH5 was higher in the male vs the female SAH group (p=0.0034). DNAH5 demonstrated a decreasing trend in the male apSAH group when comparing early (post-bleed day 0-4) DNAH5 concentration vs late (day 5+). There was not a significant difference in CSF DNAH5 concentration between the control and apSAH group.

Conclusions: This pilot study demonstrates the cilia marker DNAH5 is detectable in CSF of patients with apSAH. Additionally, males have a higher DNAH5 concentration than females with apSAH hydrocephalus. The findings of the male apSAH group requiring 75% of VPS placement and a decreasing trend of CSF DNAH5 concentration while managing hydrocephalus are of uncertain clinical importance. Altogether these findings suggest ependymal cilia changes in apSAH play a role in associated hydrocephalus.

Patient Care: This research provides significant evidence to further advance the understanding of the pathophysiology of hydrocephalus in aneurysmal-pattern subarachnoid hemorrhage, including recognition of a potential sex difference in this disease process. This study provides the framework for further research on the utilization of DNAH5 as a cerebrospinal fluid marker in aneurysmal-pattern subarachnoid hemorrhage.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify DNAH5 in cerebrospinal fluid as a marker of ependymal cilia, 2) Describe initial cerebrospinal fluid DNAH5 concentration differences between males and females in hydrocephalus following aneurysmal-pattern subarachnoid hemorrhage, 3) Discuss cerebrospinal fluid DNAH5 trend differences between males and females with hydrocephalus following aneurysmal-pattern SAH.

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