[Clinical usefulness of transcranial Doppler ultrasound imaging in the diagnosis of cerebral vasospasm in subarachnoid haemorrhage. A validation study].
BACKGROUND
During the clinical course of aneurysmal subarachnoid haemorrhage, cerebral vasospasm is one of the most dreaded medical complications. AIM. To determine the usefulness of transcranial Doppler (TCD) ultrasound imaging in diagnosing vasospasm in patients with subarachnoid haemorrhage (SAH) who were attended in a Stroke Unit.


METHODS
The study included 89 patients with SAH of a non-traumatic origin; these patients had been admitted to a Stroke Unit and were submitted to a contrast-enhanced neurovascular study and daily monitoring with TCD. Values were determined for the sensitivity, specificity, predictive power and overall precision of the TCD ultrasound imaging, together with the differences in mean flow rate and the coefficient of correlation between the gold standard test and the results of monitoring with TCD.


RESULTS
Female patients under 50 years of age with favourable initial clinical degrees were predominant. Aneurysmal SAH was prevalent and the frequency of angiographic vasospasm was 40%, in the majority of cases located in the middle cerebral arteries. Most of the patients had mean cerebral blood flow rates of or below 120 cm/s. The peaks of mean blood flow rate were obtained between the fourth and the tenth day. Overall precision, sensitivity and the predictive negative value of TCD were good. Specificity was excellent for flow rates below 130 cm/s, and the predictive positive value was low.


CONCLUSIONS
Monitoring with TCD proved to be useful for diagnosing cerebral vasospasm in patients with a good initial clinical status.
Scherle-Matamoros
C E
CE
Unidad de Ictus, Servicio de Neurología, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Havana, Cuba. csm@infomed.sld.cu
Perez-Nellar
J
J
Castro-Jimenez
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008875:Middle Aged; D012372:ROC Curve; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial / Q000706:statistics & numerical data*; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000209:etiology