Positron Emission Tomographic Cerebral Perfusion Disturbances and Transcranial Doppler Findings among Patients with Neurological Deterioration after Subarachnoid Hemorrhage

Abstract OBJECTIVE After aneurysmal subarachnoid hemorrhage, approximately 30% of patients experience delayed neurological deficits, related in part to arterial vasospasm and dysautoregulation. Transcranial Doppler (TCD) ultrasonography is commonly used to noninvasively detect arterial vasospasm. We studied cerebral perfusion patterns and associated TCD indices for 25 patients who developed clinical signs of delayed neurological deficits. METHODS Patients were treated in a neurosurgical intensive care unit and were studied if they exhibited delayed focal or global neurological deterioration. Positron emission tomographic cerebral blood flow (CBF) studies and TCD studies measuring the mean flow velocity (FV) of the middle cerebral artery and the middle cerebral artery FV/internal carotid artery FV ratio (with the internal carotid artery FV being measured extracranially at the cranial base) were performed. Glasgow Outcome Scale scores were assessed at 6 months. RESULTS A markedly heterogeneous pattern of CBF distribution was observed, with hyperemia, normal CBF values, and reduced flow being observed among patients with delayed neurological deficits. TCD indices were not indicative of the cerebral perfusion findings. The mean CBF value was slightly lower for patients who did not survive (32.3 ml/100 g/min), compared with those who did survive (36.0 ml/100 g/min, P= 0.05). CONCLUSION Among patients who developed delayed neurological deficits after aneurysmal subarachnoid hemorrhage, a wide range of cerebral perfusion disturbances was observed, calling into question the traditional concept of large-vessel vasospasm. Commonly used TCD indices do not reflect cerebral perfusion values.

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Improved Cerebral Perfusion and Metabolism after Stenting for Basilar Artery Stenosis: Technical Case Report

Neurosurgery ◽

10.1097/00006123-200106000-00048 ◽

2001 ◽

Vol 48 (6) ◽

pp. 1386-1392 ◽

Cited By ~ 1

Author(s):

Naoyuki Uchiyama ◽

Shinya Kida ◽

Takuya Watanabe ◽

Junkoh Yamashita ◽

Osamu Matsui

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Basilar Artery ◽

Cerebral Perfusion ◽

Artery Stenosis ◽

Oxygen Extraction Fraction ◽

Positron Emission Tomographic ◽

Extraction Fraction ◽

Positron Emission ◽

Basilar Artery Stenosis

Abstract OBJECTIVE Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral blood flow and metabolism as assessed by positron emission tomography after stent-assisted angioplasty for symptomatic basilar artery stenosis. CLINICAL PRESENTATION A 62-year-old man, who had undergone left superficial temporal artery to middle cerebral artery bypass surgery for left internal carotid artery occlusion 10 years previously, presented with dizziness, blurred vision, and memory disturbance. Angiography revealed severe stenosis of the proximal basilar artery. Positron emission tomographic scans revealed decreased cerebral blood flow associated with increased oxygen extraction fraction in the entire brain, particularly in the posterior circulation and the left middle cerebral artery territory. Despite medical treatment, the patient experienced worsening visual disturbance and right-sided motor weakness. INTERVENTION Ticlopidine and aspirin were used as antiplatelet agents. In addition, we used argatroban, which is a direct thrombin inhibitor, as an anticoagulant during the procedure. Predilation with a coronary artery balloon was performed, followed by placement of a GFX 3- by 8-mm stent (Arterial Vascular Engineering, Santa Rosa, CA), with excellent angiographic results. The patient made a good neurological recovery, and the postoperative positron emission tomographic scan demonstrated increases in both cerebral blood flow and cerebral metabolic rate of oxygen with a normalization of oxygen extraction fraction. CONCLUSION Stent-assisted angioplasty can provide a favorable clinical course as well as improved cerebral perfusion and metabolism for a patient with basilar artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this approach.

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Transcranial Doppler Waveforms During Intra-aortic Balloon Pump Counterpulsation for Vasospasm Detection After Subarachnoid Hemorrhage

Neurosurgery ◽

10.1093/neuros/nyx405 ◽

2017 ◽

Vol 83 (3) ◽

pp. 416-421 ◽

Cited By ~ 2

Author(s):

Nicholas A Morris ◽

Nathan Manning ◽

Randolph S Marshall ◽

E Sander Connolly ◽

Jan Claassen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Flow Velocity ◽

Doppler Ultrasound ◽

Transcranial Doppler ◽

Cerebral Perfusion ◽

Delayed Cerebral Ischemia ◽

Transcranial Doppler Ultrasound ◽

Mean Velocity ◽

Doppler Waveform ◽

Velocity Coefficient

Abstract BACKGROUND Transcranial Doppler ultrasound is a standard screening tool for vasospasm after subarachnoid hemorrhage. Prevention of vasospasm-induced delayed cerebral ischemia after subarachnoid hemorrhage depends on optimization of cerebral perfusion pressure, which can be challenged by neurogenic stress cardiomyopathy. Intra-aortic balloon pumps have been utilized to augment cerebral perfusion, but they change the transcranial Doppler waveform, altering its interpretability for vasospasm screening. OBJECTIVE To assess the features of the transcranial Doppler waveform that correlate with vasospasm. METHODS We retrospectively reviewed cases of subarachnoid hemorrhage that underwent same-day transcranial Doppler ultrasound and angiography. Transcranial Doppler waveforms were assessed for mean velocity, peak systolic velocity, balloon pump-augmented diastolic velocity, and a novel feature, “delta velocity” (balloon pump-augmented velocity − systolic velocity). Relationship of flow velocity features to vasospasm was estimated by generalized estimating equation models using a Gaussian distribution and an exchangeable correlation structure. RESULTS There were 31 transcranial Doppler and angiography pairings (12 CT angiography/19 digital subtraction angiography) from 4 patients. Fourteen pairings had proximal vasospasm by angiography. Delta velocity was associated with proximal vasospasm (coefficient –6.8 [95% CI –9.8 to –3.8], P < .001). There was no significant correlation with proximal vasospasm for mean velocity (coefficient –13.0 [95% CI –29.3 to 3.4], P = .12), systolic velocity (coefficient –8.7 [95% CI –24.8 to 7.3], P = .29), or balloon pump-augmented velocity (coefficient –15.3 [95% CI –31.3 to 0.71], P = .06). CONCLUSION Delta velocity, a novel transcranial Doppler flow velocity feature, may reflect vasospasm in patients with subarachnoid hemorrhage and intra-aortic balloon pumps.

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Transcranial Doppler ultrasonography in raised intra-cranial pressure and in intracranial circulatory arrest

Journal of Neurosurgery ◽

10.3171/jns.1988.68.5.0745 ◽

1988 ◽

Vol 68 (5) ◽

pp. 745-751 ◽

Cited By ~ 28

Author(s):

Werner Hassler ◽

Helmuth Steinmetz ◽

Jan Gawlowski

Keyword(s):

Intracranial Pressure ◽

Brain Death ◽

Intracranial Hypertension ◽

Cerebral Perfusion Pressure ◽

Transcranial Doppler ◽

Cerebral Perfusion ◽

Doppler Ultrasonography ◽

Perfusion Pressure ◽

Circulatory Arrest ◽

Transcranial Doppler Ultrasonography

✓ Transcranial Doppler ultrasonography was used to monitor 71 patients suffering from intracranial hypertension with subsequent brain death. Among these, 29 patients were also assessed for systemic arterial pressure and epidural intracranial pressure, so that a correlation between cerebral perfusion pressure and the Doppler ultrasonography waveforms could be established. Four-vessel angiography was also performed in 33 patients after clinical brain death. With increasing intracranial pressure, the transcranial Doppler ultrasonography waveforms exhibited different characteristic high-resistance profiles with first low, then zero, and then reversed diastolic flow velocities, depending on the relationship between intracranial pressure and blood pressure (that is, cerebral perfusion pressure). This study shows that transcranial. Doppler ultrasonography may be used to assess the degree of intracranial hypertension. This technique further provides a practicable, noninvasive bedside monitor of therapeutic measures.

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Faculty Opinions recommendation of Tau positron emission tomographic imaging in aging and early Alzheimer disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725883031.793537449 ◽

2017 ◽

Author(s):

Daniela Perani

Keyword(s):

Alzheimer Disease ◽

Tomographic Imaging ◽

Positron Emission Tomographic ◽

Positron Emission

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Association of transcranial Doppler blood flow velocity slow waves with delayed cerebral ischemia in patients suffering from subarachnoid hemorrhage: a retrospective study

Intensive Care Medicine Experimental ◽

10.1186/s40635-021-00378-8 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Vasilios E. Papaioannou ◽

Karol P. Budohoski ◽

Michal M. Placek ◽

Zofia Czosnyka ◽

Peter Smielewski ◽

...

Keyword(s):

Blood Flow ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Flow Velocity ◽

Transcranial Doppler ◽

Blood Flow Velocity ◽

Cerebral Blood Flow Velocity ◽

Delayed Cerebral Ischemia ◽

Area Under The Curve ◽

Slow Waves

Abstract Background Cerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial Doppler (TCD)-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia. Methods A retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in two groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Complexity of CBFV was estimated through measurement of sample entropy (SampEn). Results In the whole population (N = 32), magnitude of SWs of ipsilateral to VS side CBFV was higher during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/s, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group (N = 19, p < 0.001) and were strongly predictive of DCI, with area under the curve (AUC) = 0.745 (p = 0.02). Vasospasm caused a non-significant shortening of ipsilateral values of tau and increase in SampEn in all patients related to pre-VS measurements, as well as an insignificant increase of Mxa in DCI related to non-DCI group (N = 13). Conclusions In patients suffering from subarachnoid hemorrhage, TCD-detected VS was associated with higher ipsilateral CBFV SWs, related to pre-VS measurements. Higher CBFV SWs before VS were significantly predictive of delayed cerebral ischemia.

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