Extravasation of blood in the central nervous system (CNS) represents a very strong damaged associated molecular patterns (DAMP) which is followed by rapid inflammation and can participate in worse outcome of patients. We analyzed cerebrospinal fluid (CSF) from 139 patients after the CNS hemorrhage. We compared 109 survivors (Glasgow Outcome Score (GOS) 5-3) and 30 patients with poor outcomes (GOS 2-1). Statistical evaluations were performed using the Wilcoxon signed-rank test and the Mann-Whitney U test. Almost the same numbers of erythrocytes in both subgroups appeared in days 0-3 (p = 0.927) and a significant increase in patients with GOS 2-1 in days 7-10 after the hemorrhage (p = 0.004) revealed persistence of extravascular blood in the CNS as an adverse factor. We assess 43.3% of patients with GOS 2-1 and only 27.5% of patients with GOS 5-3 with low values of the coefficient of energy balance (KEB < 15.0) in days 0-3 after the hemorrhage as a trend to immediate intensive inflammation in the CNS of patients with poor outcomes. We consider significantly higher concentration of total protein of patients with GOS 2-1 in days 0-3 after hemorrhage (p = 0.008) as the evidence of immediate simultaneously manifested intensive inflammation, swelling of the brain and elevation of intracranial pressure.

Biomedical Centre Masaryk Hospital Ústí nad Labem 401 13 Ústí nad Labem Czech Republic

Department of Anesthesiology Perioperative Medicine and Intensive Care Masaryk Hospital Ústí nad Labem J E Purkinje University 401 13 Ústí nad Labem Czech Republic

Department of Clinical Biochemistry Masaryk Hospital Ústí nad Labem 401 13 Ústí nad Labem Czech Republic

Department of Clinical Immunology and Allergology Faculty of Medicine and University Hospital in Hradec Králové Charles University Prague 500 03 Hradec Králové Czech Republic

Department of Neurosurgery 2nd Faculty of Medicine Charles University Prague 110 00 Prague Czech Republic

Department of Neurosurgery Faculty of Medicine and University Hospital in Pilsen Charles University Prague 301 00 Pilsen Czech Republic

Department of Neurosurgery Masaryk Hospital Ústí nad Labem J E Purkinje University 401 13 Ústí nad Labem Czech Republic

Institute of Experimental Medicine Academy of Sciences of the Czech Republic 117 20 Prague Czech Republic

International Clinical Research Center St Anne's University Hospital 656 91 Brno Czech Republic

Laboratory for Cerebrospinal Fluid Neuroimmunology Pathology and Special Diagnostics Topelex 190 00 Prague Czech Republic

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