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Using transcranial Doppler sonography to augment the neurological examination after aneurysmal subarachnoid
1Neuroscience Intensive Care Unit, Virginia Commonwealth University, Medical College of Virginia Hospital, Richmond 23298, USA.
Vasospasm is the leading cause of death in patients who survive initial subarachnoid hemorrhage (SAH). Evidence of blood in the subarachnoid space on computed tomography (CT) scan can often predict the occurrence of vasospasm. Clinically, the onset of new or worsening neurological symptoms is the most reliable indicator of vasospasm. Transcranial Doppler (TCD) sonography studies can further aid the neuroscience nurse's assessment for vasospasm by measuring cerebral blood flow velocities. Physiological changes that occur during vasospasm cause the lumen of the blood vessel to decrease, increasing blood flow velocity through the affected area. Although vasospasm can only be definitively diagnosed by cerebral angiogram, TCD sonography provides a noninvasive, low-risk assessment tool that can be done at the beside. By coupling a patient's vital neurological data with blood flow velocity trends, the neuroscience nurse can anticipate the onset or worsening of vasospasm. This advanced nursing assessment allows for collaboration with the medical team to initiate and adjust appropriate therapies to improve patient outcomes.
Vasospasm is the leading cause of death in patients who survive initial subarachnoid hemorrhage (SAH). Evidence of blood in the subarachnoid space on computed tomography (CT) scan can often predict the occurrence of vasospasm. Clinically, the onset of new or worsening neurological symptoms is the most reliable indicator of vasospasm. Transcranial Doppler (TCD) sonography studies can further aid the neuroscience nurse's assessment for vasospasm by measuring cerebral blood flow velocities. Physiological changes that occur during vasospasm cause the lumen of the blood vessel to decrease, increasing blood flow velocity through the affected area. Although vasospasm can only be definitively diagnosed by cerebral angiogram, TCD sonography provides a noninvasive, low-risk assessment tool that can be done at the beside. By coupling a patient's vital neurological data with blood flow velocity trends, the neuroscience nurse can anticipate the onset or worsening of vasospasm. This advanced nursing assessment allows for collaboration with the medical team to initiate and adjust appropriate therapies to improve patient outcomes.