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Related Experiment Videos

Transcranial Doppler studies in aneurysm patients.

K Hutchison1, B Weir

  • 1Department of Surgery, University of Alberta, Edmonton, Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|November 1, 1989
PubMed
Summary

Transcranial Doppler (TCD) effectively monitors middle cerebral artery velocity (MCA-Vel) to predict vasospasm after aneurysm rupture. Elevated MCA-Vel indicates a high risk of significant vasospasm and clinical symptoms.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Diagnostic Imaging

Background:

  • Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms frequently leads to cerebral vasospasm (VSP).
  • Early detection and monitoring of VSP are crucial for managing SAH patients and preventing secondary ischemic complications.

Purpose of the Study:

  • To evaluate the utility of daily transcranial Doppler (TCD) measurements in assessing the risk of vasospasm (VSP) in patients with intracranial aneurysms.
  • To determine the correlation between middle cerebral artery velocity (MCA-Vel) and the severity of angiographic and clinical vasospasm.

Main Methods:

  • Daily transcranial Doppler (TCD) measurements of middle cerebral artery velocity (MCA-Vel) were performed in 50 patients with ruptured intracranial aneurysms and 8 patients undergoing elective clipping of unruptured aneurysms.

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  • The highest mean MCA-Vel was used as the primary parameter to assess susceptibility to clinically significant vasospasm (VSP).
  • Correlation with initial CT scans and clinical symptomatology was analyzed.

    • Main Results:

    • Surgery for unruptured aneurysms did not increase MCA-Vel.
    • MCA-Vel progressively increased after SAH, peaking between 7 and 10 days post-rupture.
    • MCA-Vel was higher on the side of the ruptured aneurysm, with a greater rise if initial CT showed blood.
    • MCA-Vel < 100 cm/sec made significant clinical VSP unlikely.
    • MCA-Vel > 200 cm/sec indicated high risk for significant VSP and clinical symptoms, with a transitional zone between 100-200 cm/sec.

    Conclusions:

    • Daily TCD monitoring of MCA-Vel is a valuable tool for predicting clinically significant vasospasm (VSP) following aneurysmal subarachnoid hemorrhage (SAH).
    • Specific MCA-Vel thresholds can help stratify patients into low, moderate, or high risk for VSP, guiding clinical management.
    • MCA-Vel measurement is a reliable, non-invasive method for assessing VSP risk in neurovascular patients.