OBJECT: Cerebral vasospasm is a common and potentially devastating complication 
of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to 
play a major role in the pathogenesis of vasospasm. The C-reactive protein (CRP) 
constitutes a highly sensitive inflammatory marker. The association of elevated 
systemic CRP and coronary vasospasm has been well established. Additionally, 
elevation of the serum CRP levels has been demonstrated in patients with aSAH. 
The purpose of the current study was to evaluate the possible relationship 
between elevated CRP levels in the serum and CSF and the development of 
vasospasm in patients with aSAH.
METHODS: A total of 41 adult patients in whom aSAH was diagnosed were included 
in the study. Their demographics, the admitting Glasgow Coma Scale (GCS) score, 
Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography 
studies, and daily neurological examinations were recorded. Serial serum and CSF 
CRP measurements were obtained on Days 0, 1, 2, 3, 5, 7, and 9. All patients 
underwent either surgical or endovascular treatment within 48 hours of their 
admission. The outcome was evaluated using the Glasgow Outcome Scale and the 
modified Rankin Scale.
RESULTS: The CRP levels in serum and CSF peaked on the 3rd postadmission day, 
and the CRP levels in CSF were always higher than the serum levels. Patients 
with lower admission GCS scores and higher Hunt and Hess and Fisher grades had 
statistically significantly higher levels of CRP in serum and CSF. Patients with 
angiographic vasospasm had higher CRP measurements in serum and CSF, in a 
statistically significant fashion (p < 0.0001). Additionally, patients with 
higher CRP levels in serum and CSF had less favorable outcome in this cohort.
CONCLUSIONS: Patients with aSAH who had high Hunt and Hess and Fisher grades and 
low GCS scores showed elevated CRP levels in their CSF and serum. Furthermore, 
patients developing angiographically proven vasospasm demonstrated significantly 
elevated CRP levels in serum and CSF, and increased CRP measurements were 
strongly associated with poor clinical outcome in this cohort.