[A transcranial Doppler method in the early diagnosis of cerebrovascular vasospasm; comparison with angiographical...

Cerebral angiography (CAG) and transcranial Doppler (TCD) were performed at the same time in 18 patients with ruptured aneurysms within 1-3 days after onset, and the results were compared. Delayed ischemic neurological deficits (DIND) accompanying vascular spasm were detected in 8 patients, but three of the 8 patients recovered from the DIND within about 2 weeks. The CAG findings were classified into the following 3 types: (1) diffuse type showing generalized spasm of intracranial arteries (8 patients), (2) proximal type with spasm in the distal part of the internal carotid arteries and/or proximal middle cerebral arteries (5 patients) and (3) peripheral type showing spasm in the peripheral part of the middle cerebral arteries (5 patients). The TCD findings could be classified into (a) high pattern type, in which the blood flow velocity had increased (13 cases), (b) paradoxical pattern type, in which the blood flow velocity was faster in the more peripheral regions (2 cases), and (c) normal pattern type (3 cases). All 13 patients classified as diffuse type (8 patients) or proximal type (5 patients) in terms of the CAG findings showed a high pattern in TCD, indicating that TCD is also capable of diagnosing vasospasm. On the other hand, two of the 5 patients with peripheral type also showed the paradoxical pattern while the remaining 3 showed the normal pattern in TCD. DIND was detected in 6 of the 15 patients with a high or paradoxical pattern in TCD.(ABSTRACT TRUNCATED AT 250 WORDS)