Is transcranial Doppler sonography useful in detecting late cerebral ischaemia after aneurysmal subarachnoid haemorrhage?
Transcranial Doppler (TCD) examination was performed in 109 patients with aneurysmal subarachnoid haemorrhage. Fifty-seven demonstrated flow velocities exceeding 120 cm/s in the middle cerebral artery. Of these, 23 developed delayed ischaemic deficit (DID). Mean flow velocity in this group was 170, SD 12.8 cm/s, in comparison with 155, SD 11.2 cm/s in the 34 patients without late signs of cerebral ischaemia. This difference is significant (p = 0.0269). In the 34 patients without DID, but TCD > 120 cm/s, 17 received anti-ischaemic therapy based on TCD values only, while 17 were given no additional treatment. The mean TCD values and the neurological outcome in the two groups were similar. A rapid increase in flow velocities of 50 cm/s or more during a 24-h period seemed to be a strong predictor of symptomatic vasospasm as seven out of 12 patients developed DID, five with permanent neurological sequelae. The study confirms results from other centres, that a strict correlation between high TCD flow velocities and occurrence of DID does not exist.
Ekelund
A
A
Department of Neurosurgery, University Hospital, Lund, Sweden.
Säveland
H
H
Romner
B
B
Brandt
L
L
D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D002536:Cerebral Arteries / Q000503:physiopathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage / Q000627:therapeutic use; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D017585:Ultrasonography, Doppler, Transcranial
D002121:Calcium Channel Blockers; D009553:Nimodipine