gms | German Medical Science

Objective: Transcranial Doppler sonography (TCD) is still used regularly in monitoring patients with subarachnoid hemorrhage to diagnose vasospasms. Nevertheless, there are some doubts in the sensitivity and specificity of the method. To evaluate its predictive significance, the TCD values were compared with brain perfusion CTs and spasmolysis.

Method: N= 210 patients which were treated in the years 2012 -2015 were evaluated. The TCD values (daily for the first 10 days) for the middle cerebral artery (MCA) mean velocity, extracranial internal carotid artery (ICA) mean velocity, Lindegaard index were correlated with perfusion CCT values (every 3 days and in case of neurological deterioration) and initiation of spasmolytic therapy. Spasmolytic therapy was given through ICA application of nimodipine. Statistical analysis was performed with Pearson's correlation analysis and Wilcoxon test.

Results: It could be shown that the Lindegaard index was highly significant in patients who received spasmolysis (1.8 vs 2.3, P<0.001). On the other side, there was no correlation of mean velocity of the MCA or the extracranial ICA in patients who received spasmolysis (MCA mean: 70 vs 80 cm /sec and ICA mean: 60 vs 70 cm /sec for no spasmolysis vs spasmolysis). There was a statistical correlation between MCA mean velocity and inverse mean transit time (MTT) (P<0.05) as well as inverse Cerebral Blood Flow and inverse cerebral blood volume (P<0.05). In the patients with spasmolytic therapy there was a correlation with Lindegaard index and MTT (P<0.01) and MCA mean velocity with MTT (P<0.05). There was also no correlation with pathological TCD values and perfusion CCT and delayed cerebral ischemia (DCI).

Conclusions: Our analysis shows a clear correlation of MCA mean velocity and Lindegaard index in patients with vasospasms who demanded a spasmolytic therapy. The Transcranial Doppler is still of significant value in diagnosing patients with vasospasms and should not be absent in the daily evaluation of patients with subarachnoid hemorrhage. The reason DCI was not correlating with pathological TCDs and perfusion CCT could be because patients with pathological TCDs and perfusion CCTs were treated before DCI occurred. On the other hand cases with DCI could be missed by the time TCD and perfusion CCT was performed and occurred after the examinations.