Cerebral Arterial Vasospasm Following Severe Head Injury: A Transcranial Doppler Study

Abstract

Transcranial Doppler ultrasound was used to determine the natural history of cerebral arterial vascular spasm following severe head injury. Doppler Flow Velocity (DFV) was measured in the anterior cerebral, middle cerebral and terminal carotid arteries. High DFVs consistent with vasospasm were identified in 68% of the 25 patients studied. They came on from between 12 h and 4 days and lasted from 12 h to 14 days. No relationship could be determined between presumed vasospasm and blood pressure, intracranial pressure or outcome. Rises in the maximum DFV value (to above 100 cm s-1) were associated with neurological deterioration in 12 instances (in 11 of these the DFV remained elevated for more than 12 h). Deterioration occurred in three instances without change in DFV. DFV rose to above 100 cm s-1 on 10 occasions without neurological change (but remained elevated for more than 12 h in only four of these). Vasospasm has been found to be more common following head injury and may be a more significant cause of deterioration than previously thought.

Subarachnoid Haemorrhage after Head Injury

“…This would also agree with the findings from Freytag [2]. 405 There are some investigations such as those performed by Compton and Teddy [13], Martin et al [14], Sander and Klingelhofer [15] and Bellner et al [16] whose results signal parallels to aneurysmal SAH. These studies have shown an increase in flow velocities consistent with vaso spasm, with a time course somewhat similar to that seen in aneurysmal vasospasm.…”

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

“…Although our sample size was small, the prevalence of CV observed in the present study was similar to that reported from several studies in adult patients with traumatic brain injury. 6,23,30,36 Our study is limited by its retrospective nature. Not every child underwent a TCD examination, and not every DSA finding could be compared with one from a TCD examination.…”

Vasospasm in traumatic brain injury

“…Furthermore, Zubkov et al has shown that more clinically mild, post-traumatic vasospasm resembles the morphological features of aneurysmal vasospasm in histopathological studies [54]. Post-traumatic vasospasm may occur earlier than postaneurysmal rupture vasospasm following the ictus, but the duration of the former for 10-12 days is similar to that of the latter [12,20,30,32,38,40,46,53]. Although vasospasm has been shown to occur following traumatic SAH (tSAH), it can be detected in 2-41% of patients with head injury by angiography [30,53] and as high as 60% by TCD [12,20,30,32,38,40,46,53] even in the absence of tSAH [36].…”

“…Whether tSAH is an independent causative factor for worse clinical outcome following TBI by deleterious processes such as vasospasm [12,16,27,32,49,53], or merely a marker of more severely incurred head injury [9,34,43] still remains highly debated [4]. Furthermore, assuming tSAH is an independent causative factor for worse clinical outcome, whether its deleterious effects are through ischemic mechanisms secondary to vasospasm as thought to occur in aSAH is still open to speculation [4].…”

“…With the advancement of neuro-diagnostic techniques, radiological or anatomical vasospasm via angiography [10,28,30,32,47] and doppler ultrasonography [8,12,20,32,33,36,38,40,42,46,53] has similarly been demonstrated following moderate and severe traumatic brain injury (TBI). Furthermore, Zubkov et al has shown that more clinically mild, post-traumatic vasospasm resembles the morphological features of aneurysmal vasospasm in histopathological studies [54].…”