Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage

Abstract

In 39 patients with a proven subarachnoid hemorrhage (SAH), the clinical status, the amount of subarachnoid blood on a computerized tomography scan obtained within 5 days after SAH, and the flow velocities (FV's) in both middle cerebral arteries (MCA's) measured by transcranial Doppler sonography were recorded daily and correlated. All patients had pathological FV's over 80 cm/sec between Day 4 and Day 10 after SAH. The side of the ruptured aneurysm showed higher FV's than did the unaffected side in cases of laterally localized aneurysms. Increase in FV preceded clinical manifestation of ischemia. A step early increase of FV's portended severe ischemia and impending infarction. Maximum FV's in the range of 120 to 140 cm/sec were not critical and in no case led to brain infarction. Maximum FV's over 200 cm/sec were associated with a tendency for ischemia, but the patients may remain clinically asymptomatic. In cases of no or only a little blood in the basal cisterns, mean FV's in both MCA's increased only moderately whereas, with thick clots of subarachnoid blood, there was a steeper and higher increase of mean FV's.

Usefulness of Transcranial Color-Coded Sonography in the Diagnosis of Cerebral Vasospasm

“…4 -6 The usefulness of conventional transcranial Doppler ultrasonography (TCD) has been clearly demonstrated in the diagnosis of cerebral vasospasm by measurement of blood flow velocity in the middle cerebral artery (MCA). [7][8][9][10][11][12][13] TCD alone is not sufficiently sensitive to detect cerebral vasospasm in the internal carotid artery (ICA) and the anterior cerebral artery (ACA), 14 -17 which is explained in part by difficulty in the detection of basal cerebral arteries. This obstacle could be avoided by using transcranial color-coded sonography (TCCS).…”

Use of Constrained Nonlinear Kalman Filtering to Detect Pathological Constriction of Cerebral Arterial Blood Vessels

“…Finally, a delay of prediction may be present because of its reliance on the changed tissue metabolic patterns. The only noninvasive and easy-to-access clinical way of predicting vasospasm, at present, is to use Transcranial Doppler (TCD) measurement of blood flow velocities in conductive cerebral arteries including middle cerebral artery (MCA), anterior cerebral artery (ACA) and intracranial carotid artery (ICA) [8], [9], [10]. Prediction of vasospasm using this conventional TCD assessment is based on absolute values of velocity (> 120 cm/s indicating medium vasospasm, > 200 cm/s indicative of severe vasospasm).…”

Prediction of Cerebral Vasospasm Using Early Stage Transcranial Doppler

“…16) The introduction of transcranial Doppler (TCD) in 1982 has provided a noninvasive approach for the evaluation of cerebral vasospasm and for monitoring the development and resolution of this condition. 1,2,9,24) Acceleration of TCD mean blood flow velocity (MFV) to more than 120 cm/sec provides approximately 80% sensitivity and specificity for the presence of angiographic vasospasm in the proximal middle cerebral artery (MCA). 20) At present, TCD is the most widely used imaging modality for diagnosing vasospasm.…”