title: [Emergency transcranial doppler ultrasound: predictive value for the development of symptomatic vasospasm in spontaneous subarachnoid hemorrhage in patients in good neurological condition].
abstract: OBJECTIVE
  To examine the predictive value of an early transcranial Doppler ultrasound (TCD) study performed in the emergency department in patients with spontaneous subarachoniod hemorrhage (SAH) in good neurological condition, in order to know which patients are at high risk of developing delayed cerebral ischemia (DCI).
  
  
  METHODS
  A descriptive observational study was carried out involving a period of 3 years.
  
  
  METHODS
  Critical Care and Emergency Department.
  
  
  METHODS
  The study consecutively included patients with SAH of grade I-III on the Hunt and Hess scale.
  
  
  METHODS
  DCI (decrease of 2 points in GCS or focal deficit), Mean Velocity (MV) of middle cerebral arteries (MCA), Lindegaard Index (IL). Sonographic vasospasm pattern (SVP) was considered if MCA-MV>120cm/sc and IL>3.
  
  
  RESULTS
  The mean age of the 122 patients was 54.1±13.7 years; 57.3% were women. SVP was detected in 24 patients (19.7%), although high velocities patterns (HVP) were present in 38 patients (31.1%). DCI developed in 21 patients (MV183+/-49cm/sc), all with previous SVP. In this group MV increased 22+/-5cm/sc/day during the first 3 days. The group without HVP (84 patients/MV of 67+/-16.6cm/sc), compared with DCI group, showed differences in highest MV (p<0.001), and also ΔMV/day (8.30+/-4,5cm/sc Vs 22+/-5cm/sc) during the first 3 days (p=0.009). In our series, ROC analysis selected the best cut-off value for ΔMV/day as 21cm/sc (p<0.001).
  
  
  CONCLUSIONS
  During the first 3 days, an increase of 21cm/s/24h in MCA-MV was associated with the development of symptomatic vasospasm. TCD is a useful tool for the early detection of patients at risk of DCI after SAH.
authors.affiliation: UGC, Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Muñoz-Sanchez
authors.forename: F
authors.initials: F
authors.lastname: Murillo-Cabezas
authors.forename: J J
authors.initials: JJ
authors.lastname: Egea-Guerrero
authors.forename: M L
authors.initials: ML
authors.lastname: Gascón-Castillo
authors.forename: P
authors.initials: P
authors.lastname: Cancela
authors.forename: R
authors.initials: R
authors.lastname: Amaya-Villar
authors.forename: M D
authors.initials: MD
authors.lastname: Rincón-Ferrari
authors.forename: J M
authors.initials: JM
authors.lastname: Flores-Cordero
authors.forename: A
authors.initials: A
authors.lastname: Cayuela
authors.forename: C
authors.initials: C
authors.lastname: García-Alfaro
mesh_terms: D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000209:etiology*