Value of Transcranial Doppler, Perfusion-CT and Neurological Evaluation to Forecast Secondary Ischemia after Aneurysmal SAH

Abstract

Neurological assessment at close intervals is the most accurate parameter to detect DV and DCI in the following 3 days. However, DIND may not be reversible. The routine acquisition of PCT in addition to daily TCD examinations seems reasonable, particularly in patients who are not amenable to a detailed neurological examination since it has a higher sensitivity and negative predictive value than TCD and leaves a lower number of undetected cases of vasospasm and infarction.

Interrater Agreement for Consensus Definitions of Delayed Ischemic Events After Aneurysmal Subarachnoid Hemorrhage

“…Combining more reliable clinical criteria with ancillary data from better quality imaging data, such as perfusion imaging, MRI, and transcranial Doppler, may provide more robust outcome measures for clinical trials and quality improvement studies. Microvascular, electrophysiological, and metabolic etiologies have been proposed as additional mechanisms causing delayed cerebral ischemia in the absence of proximal vasospasm or radiologic infarction (Westermaier et al, 2014). Given this incomplete overlap, a severe and persistent deterioration in neuromonitoring trends from any cause may also warrant consideration as an additional hospital outcome measure deserving validation against long-term clinical outcomes.…”

Bedside Ultrasound After Decompressive Craniectomy: A New Standard?

“…While digital subtraction angiography (DSA) represents the gold standard in detection of vasospasm-including eventual vasospasmolysis-DSA it is not feasible for daily routine diagnostics. In a recent study, TCD showed a high sensitivity compared with Perfusion-CT why TCD is a useful tool in daily follow-up [14,15].…”

Change in Cerebrovascular Resistance as Diagnostic Index of Cerebral Hemodynamics in Patients with Severe Combined Traumatic Brain Injury

“…This optimum can be determined using simultaneously several methods of evaluating cerebral macro-and microcirculation with subsequent calculation of derived indices and values [3][4][5]. Such approach is widely used in studying cerebral blood flow [6,7].…”

“…There is information that CVR growth is a premonitory sign of cerebral vasospasm and ischemia development [7,18,23,24]. Therefore, understanding microcirculatory bed reaction, particularly in conditions of combined traumatic brain injury (CTBI) against the background of intracranial hematoma formation, allows predicting the development of cerebral blood flow impairment.…”

“…However, evaluation of CVR status is necessary since it can serve as a predictor of posttraumatic vasospasm and secondary brain damage development [7].…”