Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage

TLDR

In 39 SAH patients, daily transcranial Doppler measurements of MCA flow velocities were recorded alongside clinical status and CT‑determined subarachnoid blood volume within five days to assess correlations. Patients with SAH showed pathological MCA flow velocities (>80 cm/s) from days 4–10, with higher velocities on the aneurysm side; early rises predicted ischemia, while velocities 120–140 cm/s were not critical, >200 cm/s indicated a risk of ischemia but could be asymptomatic, and the magnitude of velocity increase correlated with the amount of subarachnoid blood.

Abstract

In 39 patients with a proven subarachnoid hemorrhage (SAH), the clinical status, the amount of subarachnoid blood on a computerized tomography scan obtained within 5 days after SAH, and the flow velocities (FV's) in both middle cerebral arteries (MCA's) measured by transcranial Doppler sonography were recorded daily and correlated. All patients had pathological FV's over 80 cm/sec between Day 4 and Day 10 after SAH. The side of the ruptured aneurysm showed higher FV's than did the unaffected side in cases of laterally localized aneurysms. Increase in FV preceded clinical manifestation of ischemia. A step early increase of FV's portended severe ischemia and impending infarction. Maximum FV's in the range of 120 to 140 cm/sec were not critical and in no case led to brain infarction. Maximum FV's over 200 cm/sec were associated with a tendency for ischemia, but the patients may remain clinically asymptomatic. In cases of no or only a little blood in the basal cisterns, mean FV's in both MCA's increased only moderately whereas, with thick clots of subarachnoid blood, there was a steeper and higher increase of mean FV's.