Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes

D. G. Grosset, J. Straiton, M. Du Trevou, Ross Bullock

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Background and Purpose: Increased transcranial Doppler velocities and regional cerebral perfusion defects have been well demonstrated in patients with subarachnoid hemorrhage, but the clinical significance of these changes has not been clearly defined, particularly in the presymptomatic stage of cerebral vasospasm. We have tested the hypothesis that a rapid, massive rise in Doppler velocity denotes progressive vasospasm by relating Doppler velocity increases to regional cerebral blood flow changes and to the subsequent clinical course. Methods: Serial transcranial Doppler sonography was performed in 121 patients; 20 of these patients were selected for blood flow mapping on the basis of rapid increases (>50 cm/sec/24 hr) in blood flow velocity. Cerebral blood flow was mapped by single-photon emission computed tomography using technetium-99m hexamethylpropyleneamine oxime. Results: Ten of 15 patients studied before the onset of any deficit subsequently developed a focal neurological abnormality. In 14 of these 15 patients, and in a further five in which single-photon emission computed tomography was performed after the onset of a delayed neurological deficit, perfusion patterns were abnormal and correlated with sites of increased Doppler velocities. Four patients had zones of cerebral hypoperfusion but did not develop neurological deficit. Conclusions: Transcranial Doppler measurements can assist in identifying patients at risk of delayed ischemic deficit. Selection of patients for regional cerebral blood flow mapping studies and for prophylactic anti-ischemic therapy may be considered on this basis.

Original languageEnglish
Pages (from-to)674-679
Number of pages6
JournalStroke
Volume23
Issue number5
StatePublished - May 1 1992
Externally publishedYes

Fingerprint

Cerebrovascular Circulation
Subarachnoid Hemorrhage
Regional Blood Flow
Single-Photon Emission-Computed Tomography
Perfusion
Doppler Transcranial Ultrasonography
Intracranial Vasospasm
Blood Flow Velocity
Technetium
Patient Selection

Keywords

  • Cerebral blood flow
  • Cerebral vasospasm
  • Subarachnoid hemorrhage
  • Ultrasonics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes. / Grosset, D. G.; Straiton, J.; Du Trevou, M.; Bullock, Ross.

In: Stroke, Vol. 23, No. 5, 01.05.1992, p. 674-679.

Research output: Contribution to journalArticle

Grosset, D. G. ; Straiton, J. ; Du Trevou, M. ; Bullock, Ross. / Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes. In: Stroke. 1992 ; Vol. 23, No. 5. pp. 674-679.
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