Project Description

Subarachnoid haemorrhage (SAH) is a neurovascular emergency with annual UK incidence of 8/100,000. Most research in SAH focusses on immediate patient management, but survivors of SAH experience significant psychological difficulties such as depression, fatigue, apathy and cognitive impairment impacting on relationships, employment and overall quality-of-life. The mechanisms are poorly understood and there are a paucity of effective treatments.

There is growing literature regarding the role of impaired glymphatic drainage in many neurological conditions, with putative roles in causation of symptoms such as fatigue, depression and cognitive impairment. Rodent studies have shown impaired glymphatic clearance following subarachnoid haemorrhage, but the mechanistic link between glymphatic dysregulation and psychological symptoms in human SAH survivors has not been explored.

The PhD researcher will use state-of-the-art MRI techniques (such as DTI-ALPS) to provide proxy measures of perivascular lymphatic drainage in SAH survivors and control participants, and relate these to presence and severity of symptoms of depression, fatigue, apathy and cognitive impairment. Choice of patient reported outcome measures for the most relevant symptom clusters will be informed through PPIE activity at the start of the project, and co-design will be embedded in the development of the prospective study. Prospective recruitment of SAH survivors will be through partnership with the regional neurovascular/neurointerventional clinic at Nottingham University Hospitals, and advanced MRI acquisition and analysis will be supported by the Sir Peter Mansfield Imaging Centre and NIHR Nottingham BRC Imaging Theme. The overall aim is to identify potentially modifiable targets for future therapies to minimise the post-SAH psychological burden.