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    Follow-Up of Vasospasm by Transcranial Doppler Sonography in Subarachnoid Hemorrhage

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    Prabakaran Parameswaran
    This study analyzed 47 patients with subarachnoid hemorrhage using transcranial Doppler sonography to monitor cerebral blood flow velocities as a marker for vasospasm. Mild elevations were seen in the first week, peak elevations in the second week for all patients, and milder increases in the third week for some patients, consistent with the typical timeline for vasospasm. Transcranial Doppler sonography proved useful for evaluating and managing vasospasm, though the study had limitations including its observational design, small sample size, and lack of treatment details.

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    Follow-Up of Vasospasm by Transcranial Doppler Sonography in Subarachnoid Hemorrhage

    Uploaded by

    Prabakaran Parameswaran
    61 views17 pages
    This study analyzed 47 patients with subarachnoid hemorrhage using transcranial Doppler sonography to monitor cerebral blood flow velocities as a marker for vasospasm. Mild elevations were seen in the first week, peak elevations in the second week for all patients, and milder increases in the third week for some patients, consistent with the typical timeline for vasospasm. Transcranial Doppler sonography proved useful for evaluating and managing vasospasm, though the study had limitations including its observational design, small sample size, and lack of treatment details.

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    TCD in VASOSPASM

    Original Title

    Tcd in Vasospasm

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    This study analyzed 47 patients with subarachnoid hemorrhage using transcranial Doppler sonography to monitor cerebral blood flow velocities as a marker for vasospasm. Mild elevations were seen in the first week, peak elevations in the second week for all patients, and milder increases in the third week for some patients, consistent with the typical timeline for vasospasm. Transcranial Doppler sonography proved useful for evaluating and managing vasospasm, though the study had limitations including its observational design, small sample size, and lack of treatment details.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    61 views17 pages

    Follow-Up of Vasospasm by Transcranial Doppler Sonography in Subarachnoid Hemorrhage

    Uploaded by

    Prabakaran Parameswaran
    This study analyzed 47 patients with subarachnoid hemorrhage using transcranial Doppler sonography to monitor cerebral blood flow velocities as a marker for vasospasm. Mild elevations were seen in the first week, peak elevations in the second week for all patients, and milder increases in the third week for some patients, consistent with the typical timeline for vasospasm. Transcranial Doppler sonography proved useful for evaluating and managing vasospasm, though the study had limitations including its observational design, small sample size, and lack of treatment details.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 17

    Follow-up of Vasospasm by Transcranial

    Doppler Sonography in Subarachnoid


    Hemorrhage
    ACTA INFORM MED. 2017 MAR
    Jasminka Djelilovic-Vranic, Vanja Basic-Kes, Merita Tiric-Campara,
    Edina Djozic, Jasmin Kulenovic

    Presentor:Dr.Vijay Babu
    Moderator:Dr.Amiya Kumar Barik
    INTRODUCTION
    • The frequency of SAH is 5-8% in all forms of stroke, frequently in
    people between 35 and 65 years, more often in women
    • Smoking, hypertension, and excessive consumption of alcohol
    remains the most important risk factors for SAH .
    • complications of SAH :
    1. Rebleeding
    2. vasospasm
    3. acute hydrocephalus (15%)
    Cont….
    • Hemolysis of erythrocytes releases the substances, spasmogens
    primarily oxyhemoglobin, which are directly or indirectly responsible
    for the development of vasospasm
    • Other causes like metabolites of arachidonic acid, endothelin, free
    radicals, serotonin, adenosine and oxidative products of bilirubin
    • Vasospasm develops in the period from the third to fifth day after the
    hemorrhage, and reach its maximum frequency 7- days and usually
    last for 2-3 weeks
    Cont……..
    • Usually is focal or may have a diffuse distribution
    • Death as a result of vasospasm occurs in 7% of patients, and the same
    number of patients having severe, permanent neurological deficit
    • Prognostic relevant threshold of increased MBFV in the ACM by
    critical MBFV of 120 cm/s or above, a very critical MBFV >140 cm/s.
    • Sharp increase in mean blood flow velocities (MBFV) in the first few
    days after SAH is associated with poor prognosis (>20 cm/s per day).
    • The goal is to follow the occurrence of vasospasm after SAH, by the
    TCD method.
    Study design
    • Observational study
    • 47 patients with SAH were analyzed
    • 18males,29 females
    • Average age 41+ 1.62 years(22-64yrs)
    Methods

    • All respondents besides history and neurological examination


    was performed CT scan of the brain
    • TCD method was used to monitor the state of cerebral
    circulation:
     on the first day (1 to 4day) after admission,
    at the beginning of the second week (7-12 day) after
    admission
     in the third week following admission.
    Results
    • In the first measurement, a total of 9 (19.1%) patients had elevated
    MBFV in CS, as well as the ACM. The ACA elevated values were
    observed in 7 (14.8%) patients
    • In the second measurement, the total of 47 (100%) of the patients
    had elevated MBFV through CS, ACA and MCA, and the total of 45
    95.7%) patients in the ACP.
    • In the third measurement a total of 13 (27.6%) patients were
    recorded elevated MBFV in CS, ACA and ACM, while elevated in ACP
    had a total of 10 (21.2%)
    Cont….
    • Aneurysm is proven in 29 (61.7%) patients, or in 7 males (24.1%) and
    22 females (75.9%)- statisticaly significant
    • Hypertension was present in 32 (68.1%) of patients or in 12 males
    (37.5%) and 20 females (62.5%),
    • Smoking was represented in 41 (87.2%) patients, or 15 males (36.6%)
    and 26 females (63.4%)
    • The deficit of motor skills (mild hemiparesis), was present in only 11
    (23.4%) patients included in our study or 4 males (36.4%) and 7
    females (63.6%).
    MCA CS ACA PCA

    Reference range 62 + 12 54+13 50+ 12 42+ 12

    first 68 + 1.5 59+1.7 53.8 +1.5 45.1+ 1.3

    second 115.53 + 1.5 95 +0.9 86.4 +1.3 73.6 +1.2

    third 72.3 + 2.15 62.8+ 1.9 59.2 +1.6 49.2 +1.5


    Discussion
    • slight increase of MBFV up to 20% of the upper limit during
    the first measurement (first week after admission after
    stroke)
    • The highest values MBFV were recorded during the second
    measurement (at the beginning of the second week after the
    stroke).
    • Values of MBFV in the third measurement (third week of
    SAH) did not exceed 25% of the upper limit.
    Cont….
    • Results corresponded with the literature which describe that
    vasospasm develops between the third to fifth days after the
    hemorrhage, reaching maximum after 6-9 days and usually last 2-3
    weeks.
    • Condette et al., proposed that MBFV value of 130 cm/s in ACM has a
    sensitivity of 73% and specificity of 100% for the detection of
    vasospasm.
    • Burch CM et al., stated that MBFV less than 120 cm/s could reliably
    predict the absence of vasospasm (negative predictive value of 94%)
    and MBFV greater than 200 cm/s reliably to predict moderate to
    severe vasospasm
    Cont….
    • Condette Auliac stated that flow through the ACM directly
    proportional to the severity of vasospasm and vasospasm mild with
    values from 80 to 120 cm/sec, moderate at 130-200 cm/s and severe
    over 200 cm/s .
    • Creissard and Proust, report less sensitivity of TCD (<95%) for
    detecting vasospasm in CS
    • In the study by Suarez et al. which involved 199 SAH patients, the
    correlation between the increased flow recorded in TCD and
    symptomatic vasospasm was better in the CS and ACM compared
    with ACA (20).
    Conclusion
    • SAH is more common in women than men, while predilection factors
    for it are aneurysms, hypertension and smoking.
    • By TCD method were recorded milder elevated blood flow velocities
    in the first days after SAH, in about a quarter of patients
    • significantly greater increase in blood flow velocity during the second
    week in all patients and also less severe increase in blood flow
    velocity in the third week after the SAH onset in a quarter of patients.
    • TCD is the method of choice in the evaluation and management of
    vasospasm after SAH which allows the prevention of delayed cerebral
    ischemia.
    Limitations
    • Its not a randomized study
    • No treatment plan is provided
    • Sample size is small

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