Use of transcranial Doppler in monitoration of cerebral vasospasm secondary to subarachnoid hemorrhage

THESES

USE OF TRANSCRANIAL DOPPLER IN MONITORATION OF CEREBRAL VASOSPASM SECONDARY TO SUBARACHNOID HEMORRHAGE (ABSTRACT)^*. DISSERTATION. SÃO PAULO, 1995.

MÁRCIA RADANOVIC ^**

The assessment of blood flow velocities in basal arteries through transcranial Doppler (TCD) has appeared as an extremely valuable method in the management of therapeutic measures applied to patients with subarachnoid hemorrhage, before and after surgery. It allows an early diagnosis of cerebral vasospasm, early detection of those patients that are at risk to develop cerebral ischemia, as well as monitoring the benefits of the available therapy (induced hypertension / hypervolemia, use of calcium antagonists and transluminal angioplasty). An important characteristic of the method is that is is noninvasive, thus not increasing the morbidity of a condition which has some potential to deteriorate, leading the patient to a critical condition, often requiring intensive therapy. Besides, it has a relative low cost and can be performed at bedside.

We present our personal experience, in a group of patients submitted to TCD examination in Hospital das Clínicas (Faculdade de Medicina, Universidade de São Paulo). Thirty patients with diagnosis of subarachnoid hemorrhage were submitted to neurologic examination and flow velocity registrations in the intracranial arteries, to determine the correlation between flow velocity alterations and the development of clinical signs attributable to cerebral vasospasm and to compare the results with those found in the literature.

Our results were as follows: in 16 patients which developed clinical vasospasm, 14 (87.5%) showed increased flow velocities at TCD compatible with the diagnosis. From the 14 patients which did not develop clinical vasospasm, 12 (85.7%) had normal flow velocities at TCD and only 2 (12.5%) had increased velocities. In a total of 16 patients with increased flow velocities and ultrasonographic diagnosis of vasospasm, 14 (87.5%) developed neurologic deficits attributable to ischemia and only 2 (12.5%) had neurologic examinations persistently normal, but it does not exclude the possibility of vasospasm occurring without clinical signs.

Our findings, plus all the results already published in literature, point to the conclusion that TCD is an useful auxiliary method to monitory patients with subarachnoid hemorrhage, both in the early detection of those at risk of developing cerebral vasospasm (and ischemia) and as a guide to the institution of therapy.

KEY WORDS: transient cerebral ischemia, subarachnoid hemorrhage, ultrasonography, diagnosis, etiology.

**Address: Rua Cristiano Viana 163 / 192, 05411-000 São Paulo SP, Brasil.

*

Uso do Doppler transcraniano para monitorização do vasospasmo cerebral secundário a hemorragia subaracnóide (Resumo). Dissertação de Mestrado, Faculdade de Medicina da Universidade de São Paulo (Área: Neurologia). Orientador: Milberto Scaff.

Publication Dates

• Publication in this collection
  06 Dec 2000
• Date of issue
  Sept 1999