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Transcranial Doppler Studies in Aneurysm Patients

Published online by Cambridge University Press:  18 September 2015

Kenneth Hutchison  and
Bryce Weir
Kenneth Hutchison
Affiliation:
Department of Surgery, University of Alberta, Edmonton
Bryce Weir*
Affiliation:
Department of Surgery, University of Alberta, Edmonton
*
University of Alberta Hospitals, 2D2.24 Mackenzie Health Sciences Centre, 8440 - 112 Street, Edmonton, Alberta, Canada T6G 2B7
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Abstract:

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Fifty patients with ruptured intracranial aneurysms and 8 patients with elective clipping of unruptured aneurysms had daily transcranial Doppler (TCD) measurements performed. The highest mean middle cerebral artery velocity (MCA-Vel) was considered to be the best single parameter forjudging a patient's susceptibility to clinically significant vasospasm (VSP). Surgery for the clipping of unruptured aneurysms by itself does not lead to an increase in MCA-Vel. There is a progressive increase in MCA-Vel after subarachnoid hemorrhage (SAH) from aneurysms which peaks between 7 and 10 days. The MCA-Vel is higher on the side of the ruptured aneurysm and the degree of rise is greater if blood is seen on the initial CT scan. It is highly unlikely that a patient whose MCA-Vel remains under 100 cm/sec has a degree of angiographic VSP which causes clinical symptomatology. Patients whose MCA-Vel is > 200 cm/sec are at great risk of developing clinical symptomatology of VSP and are very likely to have significant angiographic VSP. There is a transitional zone in between these two levels.

Résumé:

RÉSUMÉ:

Cinquante patients porteurs d'anévrismes intracrâniens rupturés et 8 patients ayant subi un clippage électif d'anévrismes non rupturés ont eu une évaluation quotidienne par Doppler transcrânien. Nous avons estimé que la plus haute vélocité moyenne dans l'artère cérébrale moyenne (MCA-Vel) était le meilleur paramètre individuel pour évaluer la prédisposition d'un patient à développer un vasospasme cliniquement significatif (VSP). En soi, le clippage chirurgical d'un anévrisme non rupturé n'amène pas une augmentation de la MCA-Vel. Il se produit une augmentation progressive de la MCA-Vel à la suite d'une hémorragie subarachnoïdienne (SAH) qui se produit à partir d'un anévrisme, avec un pic entre le septième et le dixième jour. La MCA-Vel est plus grande du côté de l'anévrisme rupturé et le degré d'augmentation est plus considérable si l'épanchement sanguin est visible au CT scan initial. Il est peu probable qu'un patient dont la MCA-Vel demeure sous 100 cm/sec ait, à l'angiographie, un VSP qui cause une symptomatologie clinique. Les patients dont la MCA-Vel est >200 cm/sec sont plus à risque de développer une symptomatologie clinique de VSP et sont les plus susceptibles de présenter un VSP significatif à l'angiographie. Il existe une zone de tansition entre ce deux niveaux de MCA-Vel.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 16 , Issue 4 , November 1989 , pp. 411 - 416
Copyright
Copyright © Canadian Neurological Sciences Federation 1989

References

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