title: Transcranial Doppler ultrasound in the acute phase of aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Angiographic studies suggest that acute vasospasm within 48 h of aneurysmal subarachnoid hemorrhage (SAH) predicts symptomatic vasospasm. However, the value of transcranial Doppler within 48 h of SAH is unknown.
  
  
  METHODS
  We analyzed 199 patients who had at least 1 middle cerebral artery (MCA) transcranial Doppler examination within 48 h of SAH onset. Abnormal MCA mean blood flow velocity (mBFV) was defined as >90 cm/s. Delayed cerebral ischemia (DCI) was defined as clinical deterioration or radiological evidence of infarction due to vasospasm.
  
  
  RESULTS
  Seventy-six patients (38%) had an elevation of MCA mBFV >90 cm/s within 48 h of SAH onset. The predictors of elevated mBFV included younger age (OR = 0.97 per year of age, p = 0.002), admission angiographic vasospasm (OR = 5.4, p = 0.009) and elevated white blood cell count (OR = 1.1 per 1,000 white blood cells, p = 0.003). Patients with elevated mBFV were more likely to experience a 10 cm/s fall in velocity at the first follow-up than those with normal baseline velocities (24 vs. 10%, p < 0.01), suggestive of resolving spasm. DCI developed in 19% of the patients. An elevated admission mBFV >90 cm/s during the first 48 h (adjusted OR = 2.7, p = 0.007) and a poor clinical grade (Hunt-Hess score 4 or 5, OR = 3.2, p = 0.002) were associated with a significant increase in the risk of DCI.
  
  
  CONCLUSIONS
  Early elevations of mBFV correlate with acute angiographic vasospasm and are associated with a significantly increased risk of DCI. Transcranial Doppler ultrasound may be an early useful tool to identify patients at higher risk to develop DCI after SAH.
authors.affiliation: Departments of Neurology and Neurosurgery, Neurological Intensive Care Unit, Columbia University, New York, N.Y., USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Carrera
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Noeleen
authors.initials: N
authors.lastname: Ostapkovich
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.forename: David
authors.initials: D
authors.lastname: Seder
authors.forename: Errol
authors.initials: E
authors.lastname: Gordon
authors.forename: Pedro
authors.initials: P
authors.lastname: Kurtz
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
mesh_terms: D000210:Acute-Phase Reaction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002545:Brain Ischemia / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology