Abstract WP430: Utility of Prolonged Transcranial Doppler Monitoring in the Detection of Vasospasm and Stroke after Subarachnoid Hemorrhage: Is 10 days enough?

Abstract

Background: Transcranial Doppler (TCD) monitoring is commonly used to identify cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) though its utility after day 10 has been questioned. The objective of our study was to determine the frequency of vasospasm by TCD in SAH patients who underwent prolonged monitoring (beyond day 10). Methods: We retrospectively identified all SAH patients seen at Emory University Hospital in 2011 who underwent TCD monitoring beyond 10 days. Outcomes of interest included cerebral vasospasm on TCD and delayed ischemic neurological deficit (DIND) beyond day 10. Results: Of 93 patients who met inclusion criteria, 66 (71%) experienced vasospasm and 28 (31%) developed DIND beyond day 10; of patients with DIND, TCD identified vasospasm in 24 (86%). Vasospasm on TCD was a predictor of DIND in univariate analysis (OR 3.29; 95% CI 1.015 to 10.63) but was not significant in multivariable analysis when adjusted for admission Hunt and Hess score. Conclusion: Prolonged TCD monitoring (beyond day 10) identified a high frequency of cerebral vasospasm in our subset of patients though was not a significant predictor of DIND in multivariable analysis. Prolonged TCD monitoring needs to be evaluated in a prospective study to determine its utility as a predictor of DIND.