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.

scholarly journals Vasospasm severity is associated with cerebral infarction after subarachnoid hemorrhage

2021 ◽  
Author(s):  
Samuel B Snider ◽  
Ibrahim Migdady ◽  
Sarah L LaRose ◽  
Morgan E Mckeown ◽  
Robert W Regenhardt ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Time Varying ◽  
Single Center ◽  
Early Screening ◽  
Angiographic Vasospasm

AbstractBackgroundThe presence of angiographic vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is associated with delayed-cerebral ischemia (DCI)-related cerebral infarction and worsened neurological outcome. Transcranial doppler (TCD) measurements of cerebral blood velocity are commonly used after aSAH to screen for vasospasm. We sought to determine whether time-varying TCD measured vasospasm severity is associated with cerebral infarction and to investigate the performance characteristics of different time/severity cutoffs for predicting cerebral infarction.MethodsWe used a retrospective, single-center cohort of consecutive adult aSAH patients with angiographic vasospasm and at least one TCD study. Our primary outcome was DCI-related cerebral infarction, defined as an infarction developing at least 2 days after any surgical intervention without an alternative cause. Time-varying TCD vasospasm severity was defined ordinally (absent, mild, moderate, severe) by the most abnormal vessel on each post-admission hospital day. Cox proportional-hazards models were used to examine associations between time-varying vasospasm severity and infarction. The optimal TCD-based time/severity thresholds for predicting infarction were then identified using the Youden J statistic.ResultsOf 218 aSAH patients with angiographic vasospasm, 27 (12%) developed DCI-related infarction. As compared to those without infarction, patients with infarction had higher modified Fisher scale (mFS) scores, and an earlier onset of more-severe vasospasm. Adjusted for mFS, vasospasm severity was associated with infarction (aHR 1.9, 95% CI: 1.3-2.6). A threshold of at least mild vasospasm severity on hospital day 4 had a negative predictive value of 92% for the development of infarction, but a positive predictive value of 25%.ConclusionsIn aSAH, TCD-measured vasospasm severity is associated with DCI-related infarction. In a single-center dataset, a TCD-based threshold for predicting infarction had a high negative predictive value, supporting its role as an early screening tool to identify at-risk patients.

scholarly journals The added value of parenchymal transcranial Doppler sonography at the Emergency Room: case report of an unusual gait disorder

2019 ◽  
Author(s):  
Massimiliano Godani ◽  
Giuseppe Lanza ◽  
Rita Bella ◽  
Lucia Trevisan ◽  
Raffaele Ferri
Keyword(s):  
Emergency Room ◽  
Movement Disorder ◽  
Neurological Examination ◽  
Movement Disorders ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Gait Disorder ◽  
Wide Range ◽  
History Of

Abstract Background: the growing application of parenchymal transcranial Doppler sonography (pTCS) helps the diagnosis of a wide range of neurological diseases, especially movement disorders. Here, we report a patient with an unusual gait disorder in whom pTCS performed at the Emergency Room rapidly provided diagnostic clues towards a degenerative movement disorder. Case presentation: A 60-year old man presented at the Emergency Room with a rapidly progressive history of walking difficulty, without falls. He had no family history of neurodegenerative or psychiatric diseases. Because of a depressive disorder arisen one year earlier, he was under oral treatment with escitalopram 10 mg and amisulpride 100 mg daily. Neurological examination showed a gait characterized by ataxia, rigidity, and limping; he also had mild oro-facial and hands dyskinesia, some of which were also present during walking. Brain computed tomography was normal. A pTCS performed at the Emergency Room showed hyperechogenicity of the substantia nigra and the caudate nucleus, bilaterally. This pattern is suggestive of Huntington’s disease (HD), as confirmed by the molecular genetic test carried out later. Other laboratory tests, standard electroencephalogram, and 1.5-T brain MRI were normal.Conclusions: to date, this is the first report of HD sonographically detected at the Emergency Room. This supports the view that pTCS can be easily implemented in the diagnostic algorithm and differential diagnosis of movement disorders even in an urgency setting. Notably, conventional MRI did not detect, at this stage, any abnormality; this further highlights the diagnostic utility of pTCS, which also allowed to exclude a drug-induced effect or a different movement disorder. In clinically suspected cases, pTCS can extend the neurological examination by providing diagnostic clues more rapidly and less expensively than neuroimaging.

scholarly journals The added value of parenchymal transcranial Doppler sonography at the Emergency Room: case report of an unusual gait disorder

2019 ◽  
Author(s):  
Massimiliano Godani ◽  
Giuseppe Lanza ◽  
Rita Bella ◽  
Lucia Trevisan ◽  
Raffaele Ferri
Keyword(s):  
Emergency Room ◽  
Movement Disorder ◽  
Neurological Examination ◽  
Movement Disorders ◽  
Transcranial Doppler ◽  
Doppler Sonography ◽  
Transcranial Doppler Sonography ◽  
Gait Disorder ◽  
Wide Range ◽  
History Of

Abstract Background: the growing application of parenchymal transcranial Doppler sonography (pTCS) helps the diagnosis of a wide range of neurological diseases, especially movement disorders. Here, we report a patient with an unusual gait disorder in whom pTCS performed at the Emergency Room rapidly provided diagnostic clues towards a degenerative movement disorder. Case presentation: A 60-year old man presented at the Emergency Room with a rapidly progressive history of walking difficulty, without falls. He had no family history of neurodegenerative or psychiatric diseases. Because of a depressive disorder arisen one year earlier, he was under oral treatment with escitalopram 10 mg and amisulpride 100 mg daily. Neurological examination showed a gait characterized by ataxia, rigidity, and limping; he also had mild oro-facial and hands dyskinesia, some of which were also present during walking. Brain computed tomography was normal. A pTCS performed at the Emergency Room showed hyperechogenicity of the substantia nigra and the caudate nucleus, bilaterally. This pattern is suggestive of Huntington’s disease (HD), as confirmed by the molecular genetic test carried out later. Other laboratory tests, standard electroencephalogram, and 1.5-T brain MRI were normal.Conclusions: to date, this is the first report of HD sonographically detected at the Emergency Room. This supports the view that pTCS can be easily implemented in the diagnostic algorithm and differential diagnosis of movement disorders even in an urgency setting. Notably, conventional MRI did not detect, at this stage, any abnormality; this further highlights the diagnostic utility of pTCS, which also allowed to exclude a drug-induced effect or a different movement disorder. In clinically suspected cases, pTCS can extend the neurological examination by providing diagnostic clues more rapidly and less expensively than neuroimaging.

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