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Fig. 1 | BMC Neurology

Fig. 1

From: The HeMoVal study protocol: a prospective international multicenter cohort study to validate cerebrospinal fluid hemoglobin as a monitoring biomarker for aneurysmal subarachnoid hemorrhage related secondary brain injury

Fig. 1

The pathophysiological concept of cell-free hemoglobin toxicity after aneurysmal subarachnoid hemorrhage: Usually with a delay of a few days after aneurysm rupture, hemoglobin (Hb) tetramers are released from lysing erythrocytes of the subarachnoid hematoma. The dimerization of Hb and hence the smaller molecular size allows for a delocalization across tissue barriers into vulnerable anatomical sites, such as the wall of blood vessels or the brain parenchyma. Within these compartments Hb exerts its toxicity through nitric oxide depletion and heme toxicity. (Illustrations by Rok Humar)

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