gms | German Medical Science

Objective: Delayed ischemic neurological deficit (DIND) due to cerebral vasospasm still is the major cause of in-hospital neurological deterioration and morbidity in patients, who have suffered subarachnoid hemorrhage (SAH). Once vasospasm is diagnosed, various measures may be undertaken to increase cerebral perfusion and/or directly treat spastic vessels. This study evaluated the use of the Perfusion-CT in the diagnosis of cerebral vasospasm.

Methods: 105 patients with SAH received regular CT-scans and Perfusion-CTs on days 3/4, 6/7, 9/10 after admission and, in case of longer hospitalization, in 3-day intervals thereafter. Cerebral Blood Flow (CBF), Blood Volume (BV) and Time-To-Peak (TTP) parameters were determined. Prior to discharge, a final CT-scan was performed to determine ischemic lesions at the end of therapy. Simultaneous close clinical monitoring and regular transcranial doppler sonography (TCD) were performed throughout the course of therapy.

Results: Deficits in CBF and BV measurements resemble already infarcted tissue in native CT-scans. Time-To-Peak deficits most closely correlate with angiographic and clinical vasospasm. Still, clinical deterioration is the most sensitive and specific parameter for cerebral vasospasm. TCD is sensitive, but less specific for the prediction of vasospasm.

Conclusions: If appropriate clinical evaluation is possible, it should be the leading parameter in the decision whether to undertake further measures such as reangiography/angioplasty or enforced hyperdynamic therapy. In patients who cannot be evaluated neurologically, Perfusion-CT is a helpful adjunct in the diagnosis of vasospasm.