S-100B and NSE: markers of initial impact of subarachnoid haemorrhage and their relation to vasospasm and outcome

S100-B and neuron specific enolase (NSE) are known predictors of outcome in head injured and stroke patients. This study was conducted to test the hypothesis that S-100B and NSE can predict the development of vasospasm and outcome within the first 3 days after subarachnoid haemorrhage (SAH). Fifty-one SAH patients (mean age 51 ± 11 years, male : female ratio 1.0 : 1.6, mean World Federation of Neurological Surgeons [WFNS] Grade 3 ± 1.5) were included in the study. S100-B and NSE were recorded in venous blood across the first 3 days post-SAH. Vasospasm was diagnosed if mean blood flow velocity of the middle cerebral artery was greater than 120 cm/s and Lindegaard ratio >3. Glasgow Outcome Score (GOS) and cranial CT scans were recorded at 6 months. Normal, intermediate and high S-100B values were seen in 24%, 51% and 25% of patients, respectively. In patients with S-100B > 1 μg/L, Fisher Grade 4 and WFNS 4–5 were both seen in 77% of cases. S-100B was significantly higher in those patients who did not develop vasospasm. In addition, S-100B values were significantly higher in those patients who died than in those with unfavourable or favourable outcome. NSE was normal, intermediate and high in 82%, 8% and 10% of patients, respectively. Patients with WFNS 4–5 and/or Fisher Grade 4 had significantly higher NSE values than all others. Across the first 3 days after SAH, measuring S-100B is useful to predict outcome and vasospasm.