Abstract
Our objective was to examine the impact of transcranial Doppler ultrasound (TCD) vasospasm
monitoring on clinical decision-making following subarachnoid hemorrhage (SAH). The
records of 50 randomly selected patients undergoing serial TCD monitoring following
SAH were reviewed. Dates and results of TCDs and cerebral angiograms, the use of hypertensive
hemodilution (HH) therapy, and the development of new neurological deficits were recorded.
The independent effects of TCD-defined vasospasm and new neurological deficits on
patient management were determined with multiple logistical regression. Results were
validated in a second randomly selected, 50 patient cohort. Mild or moderate TCD-defined
vasospasm developed in 76% of patients 5.8 ± 0.5 days after SAH; 38% developed severe
TCD-defined vasospasm after 7.9 ± 0.7 days. Focal neurological deficits occurred in
50% after 5.7 ± 0.6 days with TCD abnormalities preceding the deficit by 2.5 ± 0.7
days in 64%. TCD-defined vasospasm or a new neurological deficit explained 60% of
the variance in the use of HH therapy (P =.005). New neurological deficits increased the odds of HH therapy 33-fold (P =.004) whereas there was no independent effect of TCD-defined vasospasm. These variables
explained 64% of the variance in the performance of angiography (P =.0002). An abnormal TCD did not increase the odds of angiography whereas its use
increased 28-fold (P =.01) after a neurological deficit developed. These results were confirmed in an
independent cohort. We concluded that TCD-defined vasospasm did not independently
influence the use of HH therapy or angiography with both decisions associated with
the development of new neurological deficits. As TCD-defined vasospasm preceded the
neurological deficit in 64%, earlier intervention might reduce the incidence of vasospasm-related
stroke in institutions with similar practice patterns. Copyright © 2003 by National
Stroke Association
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The effect of surgery on the severity of vasospasm.J Neurosurg. 1994; 80: 433-439
- Are the calcium antagonists really useful in cerebral aneurysmal surgery? A retrospective study.Neurosurgery. 1994; 34 (discussion 36-37): 30-36
- Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator.J Neurosurg. 1993; 78: 430-437
- Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid hemorrhage.Neurosurgery. 1988; 23: 699-704
- A review of cerebral vasospasm in aneurysmal subarachnoid hemorrhage, part I: incidence and effects.J Clinical Neurosci. 1994; 1: 19-26
- Cerebral vasospasm following aneurysmal subarachnoid hemorrhage.Stroke. 1985; 16: 562-572
- The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results.J Neurosurg. 1990; 73: 18-36
- Prophylactic hypervolemia without calcium channel blockers in early aneurysm surgery.Neurosurgery. 1992; 30: 12-16
- Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension.Stroke. 1987; 18: 365-372
- Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries.J Neurosurg. 1982; 57: 769-774
- Usefulness of transcranial color-coded sonography in the diagnosis of cerebral vasospasm.Stroke. 1991; 30: 1091-1098
- Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage.Neurology. 1989; 39: 1514-1518
- Evaluation of cerebrovascular disease by combined extracranial and transcranial Doppler sonography. Experience in 1,039 patients.Stroke. 1987; 18: 1018-1024
- Cerebral blood velocity in subarachnoid haemorrhage: a transcranial Doppler study.J Neurol Neurosurg Psychiatry. 1987; 50: 1499-1503
- Transcranial Doppler ultrasonography: influence on scheduling of angiography and delayed surgery for ruptured intracranial aneurysms.J Neurosurg Sci. 1994; 38: 21-27
- A new, more dependable methodology for the use of transcranial Doppler ultrasonography in the management of subarachnoid haemorrhage.Acta Neurochir. 1996; 138: 1070-1077
- Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements.Acta Neurochir. 1989; 100: 12-24
- Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound.J Neurosurg. 1987; 66: 718-728
- Predictors of outcome after subarachnoid hemorrhage.Neurochirurgie. 1994; 40: 18-30
- A minor revision of Hunt and Hess scale.Stroke. 2001; 32: 2208-2213
- Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage.Neurosurgery. 1999; 44 (discussion 1247-1248): 1237-1247
- Value of transcranial Doppler examination in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage.Neurosurgery. 1988; 22: 813-821
- Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound.J Neurosurg. 1984; 60: 37-41
- The three phases of vasospasm.Surg Neurol. 1982; 18: 40-45
- Morphologic changes in cerebral arteries after subarachnoid hemorrhage.Neurosurg Clin N Am. 1990; 1: 417-432
- Cerebral hemodynamics in subarachnoid hemorrhage evaluated by transcranial Doppler sonography. Part 1. Reliability of flow velocities in clinical management.Neurosurgery. 1993; 33 (discussion 8-9): 1-8
- Comparison of transcranial Doppler investigation of aneurysmal vasospasm with digital subtraction angiographic and clinical findings.Neurosurgery. 1999; 45 (discussion 449-50): 443-449
Article info
Publication history
Accepted:
December 7,
2002
Received:
September 4,
2002
Footnotes
*Supported in part by an AHA Student Scholarship (M J. M.) and a NIH Mid-career Investigator's Award (NS02165) (L. B. G.).
**Address correspondence requests to Larry B. Goldstein, MD, Box 3651 - DUMC, Durham, NC 27710. E-mail: [email protected]
★1052-3057/03/1202-0001$30.00/0
Identification
Copyright
© 2003 National Stroke Association. Published by Elsevier Inc. All rights reserved.
