Transcranial Doppler Sonography Defined Vasospasm, Ischemic Brain Lesions, and Delayed Ischemic Neurological Deficit in Younger and Elderly Patients after Aneurysmal Subarachnoid Hemorrhage

2020 ◽  
Vol 138 ◽  
pp. e718-e724
Author(s):  
Michael Bender ◽  
Eva Richter ◽  
Frank P. Schwarm ◽  
Malgorzata A. Kolodziej ◽  
Eberhard Uhl ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Neurological Deficit ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Transcranial Doppler Sonography ◽  
Brain Lesions ◽  
Ischemic Brain ◽  
Delayed Ischemic Neurological Deficit

Use of transcranial Doppler sonography to predict development of a delayed ischemic deficit after subarachnoid hemorrhage

1993 ◽  
Vol 78 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Donald G. Ghosset ◽  
John Straiton ◽  
Isobel McDonald ◽  
Muriel Cockburn ◽  
Ross Bullock
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurological Deficit ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Peak Velocity ◽  
Transcranial Doppler Sonography ◽  
Early Period ◽  
Delayed Ischemic Neurological Deficit ◽  
Rate Of Increase ◽  
Significant Difference

✓ Blood flow velocity was recorded from the middle or anterior cerebral and extracranial internal carotid arteries using transcranial Doppler sonography (TCD) in 121 unselected consecutive patients with acute aneurysmal subarachnoid hemorrhage (SAH). Recordings were made daily or every 2nd day after SAH for a 14-day period. The highest recorded velocity was greater in the 47 patients who developed a delayed ischemic neurological deficit (186 ± 6 cm sec−1; mean ± standard error of the mean) than in the 74 patients who did not develop a neurological deficit (149 ± 5 cm sec−1) (p < 0.001, Mann-Whitney test). Peak velocity recordings can thus assist in the diagnosis of delayed ischemic neurological deficit; however, peak velocity was often recorded only after the onset of neurological deficit. When only those readings made before the onset of neurological deficit were considered, there was no significant difference in peak velocity between the groups (157 ± 8 cm sec−1 vs. 149 ± 5 cm sec−1, respectively). Alternative TCD parameters for predicting delayed neurological deficit were therefore sought. The rate of increase in TCD velocity, recorded during the first few days after SAH, was significantly higher in the patients who later developed a neurological deficit. A maximum velocity increase of 65 ± 5 cm sec−1 per 24-hour period was recorded in patients who later developed a neurological deficit, compared to 47 ± 3 cm sec−1 24 hrs−1 in patients who did not develop a delayed neurological deficit (p = 0.003). A rise of more than 50 cm sec−1 24 hrs−1 identifies those patients who are most likely to develop a delayed ischemic neurological deficit after SAH. This can be applied prospectively to individual cases. Serial TCD studies in the early period after SAH are thus of value to identify patients who can be selected for prophylactic therapy, which may prevent or ameliorate development of delayed ischemic neurological deficits.

Perfusion-weighted Magnetic Resonance Imaging in Patients with Vasospasm: A Useful New Tool in the Management of Patients with Subarachnoid Hemorrhage

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Frank Hertel ◽  
Christof Walter ◽  
Martin Bettag ◽  
Maria Mörsdorf ◽  
R. Loch Macdonald ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Subarachnoid Hemorrhage ◽  
Magnetic Resonance ◽  
Neurological Deficit ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Diffusion Weighted Mri ◽  
Resonance Imaging ◽  
Weighted Magnetic Resonance Imaging

Abstract OBJECTIVE: Cerebral vasospasm (VSP) is one of the most important risk factors for the development of a delayed neurological deficit after subarachnoid hemorrhage (SAH). Perfusion-weighted magnetic resonance imaging (pwMRI) provides the possibility of detecting tissue at risk for infarction. The objective of our study was to evaluate the feasibility and impact of pwMRI in the management of SAH patients. METHODS: From a consecutive series of 180 patients experiencing SAH and treated at our institution over a 3-year period, we identified 20 who underwent pwMRI during their acute illness. For these 20 patients, the results of pwMRI were compared with the results of diffusion-weighted MRI, transcranial Doppler sonography, and neurological examinations performed at the same time and with repeated pwMRI examinations of the same patient at different times. RESULTS: Nineteen of 20 patients showed perfusion changes predominantly in the time maps. Fifteen of 19 patients with changes in pwMRI had a neurological deficit at the same time. In 7 of 15 patients with neurological deterioration, transcranial Doppler sonography showed signs of VSP, whereas all 15 patients showed alterations in pwMRI. The areas of perfusion changes in pwMRI correlated well with the neurological deficits of the patients and were larger than the areas of changed diffusion in diffusion-weighted MRI performed at the same time. There were no clinical complications with regard to the pwMRI examinations. CONCLUSION: pwMRI is safe and helpful in the management of patients with VSP after SAH. The sensitivity of pwMRI is higher than that of transcranial Doppler sonography in the detection of decreased perfusion as a result of VSP. pwMRI can detect tissue at risk before definitive infarction occurs and therefore may lead to a change of therapy in those patients.

scholarly journals Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ekkehard Kunze ◽  
Mirko Pham ◽  
Furat Raslan ◽  
Christian Stetter ◽  
Jin-Yul Lee ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Negative Predictive Value ◽  
Neurological Examination ◽  
Transcranial Doppler ◽  
Predictive Value ◽  
Doppler Sonography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Transcranial Doppler Sonography ◽  
Perfusion Ct ◽  
Angiographic Vasospasm

Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD), and Perfusion-CT (PCT) to detect angiographic vasospasm.Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND), pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF) were calculated.Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s) had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD.Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH.

Is routine transcranial Doppler ultrasound monitoring useful in the management of subarachnoid hemorrhage?

1998 ◽  
Vol 88 (2) ◽  
pp. 272-276 ◽  
Author(s):  
Joanna M. Wardlaw ◽  
Ruth Offin ◽  
Graham M. Teasdale ◽  
Evelyn M. Teasdale
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurological Deficit ◽  
Transcranial Doppler ◽  
Controlled Trial ◽  
Positive Contribution ◽  
Content Type ◽  
Delayed Ischemic Neurological Deficit ◽  
Ultrasound Monitoring ◽  
The Impact ◽  
Fine Print

Object. In this prospective observational study, the authors assess the impact of routine transcranial Doppler (TCD) ultrasound monitoring on the diagnosis, management, and outcome of delayed ischemic neurological deficit complicating subarachnoid hemorrhage (SAH). Methods. Over a 10-month period 186 patients admitted to a regional neurosciences center were included in the study. Three times a week, routine TCD examinations performed by neuroradiographers made an important positive contribution to the diagnosis of delayed ischemic neurological deficit in 72% of patients with this complication and led to altered management for the benefit of the patient in 43%. In 9% of patients with recent SAH, it was believed that the outcome might have been better if the TCD result had been acted upon appropriately. The TCD results did not adversely influence management or outcome and were generally accurate when compared with those obtained on angiography. Conclusions. A routine TCD service provided by neuroradiographers is accurate and useful in diagnosing and managing elevated blood velocities and ischemic neurological deficit following SAH. In addition, it is possible that if the information gleaned from TCD findings was used more often in patient management, outcome might be improved; however, a randomized controlled trial is necessary to assess both these points definitively.

Is routine transcranial Doppler ultrasound useful in the management of subarachnoid hemorrhage?

1997 ◽  
Vol 3 (4) ◽  
pp. E3 ◽  
Author(s):  
Joanna M. Wardlaw ◽  
Ruth Offin ◽  
Graham M. Teasdale ◽  
Evelyn M. Teasdale
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurological Deficit ◽  
Transcranial Doppler ◽  
Prospective Observational Study ◽  
Controlled Trial ◽  
Transcranial Doppler Ultrasound ◽  
Positive Contribution ◽  
Delayed Ischemic Neurological Deficit ◽  
Ultrasound Monitoring ◽  
The Impact

In this prospective observational study, the authors assess the impact of routine transcranial Doppler (TCD) ultrasound monitoring on the diagnosis, management, and outcome of delayed ischemic neurological deficit complicating subarachnoid hemorrhage (SAH). Over a 10-month period 186 patients admitted to a regional neurosciences center were included in the study. Three times a week, routine TCD examinations performed by neuroradiographers made an important positive contribution to the diagnosis of delayed ischemic neurological deficit in 72% of patients with this complication and altered management for the benefit of the patient in 43%. In 9% of patients with recent SAH, it was believed that the outcome might have been better if the TCD result had been acted upon appropriately. The TCD results did not adversely influence management or outcome and were accurate when compared with those obtained on angiography. The authors conclude that a routine TCD service provided by neuroradiographers is accurate and useful in diagnosing and managing elevated blood velocities and ischemic neurological deficit following SAH. In addition, it is possible that if the information gleened from TCD findings was used more often in patient management, outcome might be improved; however, a randomized controlled trial is necessary to assess this definitively.

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