Transcranial Doppler as a routine in the treatment of vasospasm following subarachanoid hemorrhage (SAH).
BACKGROUND
Vasospasm is an important complication observed after subarachnoid hemorrhage (SAH) and is a frequent cause of mortality and morbidity. We present our routine management of vasospasm after SAH and emphasize the importance of transcranial Doppler (TCD) ultrasonography in this management.


METHODS
Historical records and images were sampled from June 2005 to September 2011 for 110 patients with SAH due to ruptured aneurysm in the anterior circulation. All surviving patients were followed after discharge. Vasospasm was defined as mild (Lindegaard index 3-4), moderate (Lindegaard index 4-5), and severe (Lindegaard index greater than 5). We excluded patients treated after 72 h of symptom onset. TCD was performed twice per day.


RESULTS
Ninety-nine patients had surgical clipping of the aneurysm, and 11 had endovascular treatment. Seventy patients treated by clipping and six treated by endovascular procedure had vasospasm. Of the 70 clipped patients with vasospasm, 40 had mild vasospasm, 13 had moderate vasospasm, and 17 had severe vasospasm. All six patients treated by coils had moderate vasospasm. The average duration of vasospasm was 9 days (from 7 to 32 days).


CONCLUSIONS
TCD was crucial for monitoring patients with SAH, and to identify which patients will have a higher risk of developing vasospasm.
Department of Neurology, Santa Paula Hospital, Sao Paulo, Brazil. rfsimm@gmail.com
Renata F
RF
Simm
Paulo H Pires
PH
de Aguiar
M
M
de Oliveira Lima
Bernardo L
BL
Paiva
D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013525:Surgical Instruments / Q000009:adverse effects; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology*