Publication date: August 2019
Source: World Neurosurgery, Volume 128
Author(s): Marie-Christine Brunet, Stephanie H. Chen, Priyank Khandelwal, Joshua M. Hare, Robert M. Starke, Eric C. Peterson, Dileep R. Yavagal
Background
Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality (30%–40%) and morbidity with long-term physical, neurologic, and psychological impairments; most patients present with high initial Hunt and Hess grade. In view of the great need for efficacious therapies for high-grade SAH, recent animal studies have demonstrated improved outcomes with administration of mesenchymal stem cells (MSCs) as a potential neuroregenerative strategy. We present the first case of human intravenous administration of MSCs after aneurysmal SAH.
Clinical Presentation
An 80-year-old man presented with sudden severe headache with nausea and vomiting. Computed tomography demonstrated SAH with hydrocephalus from a ruptured basilar tip aneurysm. Initial examination of the patient showed Hunt and Hess grade 5 and World Federation of Neurosurgical Societies grade 5. The patient was treated with external ventricular drain placement and coiling of aneurysm. The patient received an infusion of intravenous bone marrow–derived allogeneic MSCs on day 3 postbleed. The patient made a better recovery than anticipated with a modified Rankin Scale score of 3 at 6 months.
Conclusions
Several studies using models of ischemic brain injury have found that administration of MSCs may improve functional neurologic recovery and decrease brain lesion volume. Although there have been limited human studies in patients with stroke, the role of stem cell therapy for aneurysmal SAH remains unclear. This is the first case of use of MSCs in a patient for treatment of aneurysmal SAH. In conjunction with the promising results in animal studies, this encouraging preliminary case report supports the need for additional clinical trials.
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