Transcranial Doppler ultrasound in the acute phase of aneurysmal subarachnoid hemorrhage.
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.
Carrera
Emmanuel
E
Departments of Neurology and Neurosurgery, Neurological Intensive Care Unit, Columbia University, New York, N.Y., USA.
Schmidt
J Michael
JM
Oddo
Mauro
M
Ostapkovich
Noeleen
N
Claassen
Jan
J
Rincon
Fred
F
Seder
David
D
Gordon
Errol
E
Kurtz
Pedro
P
Lee
Kiwon
K
Connolly
E Sander
ES
Badjatia
Neeraj
N
Mayer
Stephan A
SA
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