Abstract
Introduction: There is still controversial discussion of the value of transcranial Doppler (TCD) in predicting vasospasms in patients with aneurysmal SAH (aSAH). A newer method of predicting a delayed ischemic deficit (DCI) is CT perfusion (CTP), although it is not quite understood which kind of perfusion deficit is detected by this method since it seems to also identifying microcirculatory disturbances. We compared the TCD and CTP values with angiography and evaluated TCD and CTP changes before and after patients received intra-arterial spasmolytic therapy.
Material and Methods: Retrospective analysis of TCD, CTP, and angiographies of N = 77 patients treated from 2013 to 2016. In 38 patients intra-arterial spasmolysis had been performed, and in these cases TCD and CTP data were compared before and after lysis. Thirty-nine patients had a pathological CTP but no angiographically seen vasospasm.
Results: There was no correlation between the known thresholds of mean transit time (MTT) in CTP and vasospasm or with mean velocities in TCD and vasospasm. After spasmolysis in patients with vasospasms, only the MTT showed significant improvement, whereas TCD velocities and Lindegaard index remained unaffected.
Conclusion: TCD and CTP seem to identify different pathological entities of DCI and should be used supplementary in order to identify as many patients as possible with vasospasms after aSAH.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Malhotra K, Conners JJ, Lee VH, Prabhakaran S. Relative changes in transcranial Doppler velocities are inferior to absolute thresholds in prediction of symptomatic vasospasm after subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2014;23:31–6.
Jabbarli R, Gläsker S, Weber J, Taschner C, Olschewski M, Velthoven VV. Predictors of severity of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2013;22:1332–9.
Zhang H, Zhang B, Li S, Liang C, Xu K, Li S. Whole brain CT perfusion combined with CT angiography in patients with subarachnoid haemorrhage and cerebral vasospasm. Clin Neurol Neurosurg. 2013;115:2496–501.
Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–37.
Han SJ, Rutledge WC, Englot DJ, Winkler EA, Browne JL, Pflugrath L, Cronsier D, Abla AA, Kliot M, Lawton M. The Presto 1000: a novel automated transcranial Doppler ultrasound system. J Clin Neurosci. 2015;22:1771–5.
Deb S, Gogos AJ, Drummond KJ, Teddy PJ. The role of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage. J Clin Neurosci. 2012;19:950–5.
Mathys C, Martens D, Reichelt DC, et al. Long-term impact of perfusion CT data after subarachnoid hemorrhage. Neuroradiology. 2013;55:1323.
Ehrlich G, Kirschning T, Wenz H, Hegewald AA, Groden C, Schmiedek P, Scharf J, Seiz-Rosenhagen M. Is there an influence of routine daily transcranial doppler examination on clinical outcome in patients after aneurysmal subarachnoid hemorrhage. World Neurosurg. 2016;88:214–21.
Holligworth M, Chen PR, Goddard AJP, Coulthard A, Söderman M, Bulsara KR. Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia. World Neurosurg. 2015;83:1120–6.
Aaslid R, Huber P, Nornes H. Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg. 1984;60:37–41.
Sloan MA. Detection of Vasospasm following subarachnoid haemorrhage. In: Babikian VL, Wechsler LR, editors. Transcranial Doppler sonography. St Louis: Mosby-Year Book; 1993. p. 105–27.
Vora YY, Suarez-Almazor M, Steinke DE, et al. Role of transcranial doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid haemorrhage. Neurosurgery. 1999;44:1237–47.
Suarez JI, Qureshi AI, Yahia AB, et al. Symptomatic vasospasm diagnosis after subarachnoid haemorrhage: evaluation of transcranial Doppler ultrasound and cerebral angiography as related to compromised vascular distribution. Crit Care Med. 2002;30:1348–55.
Grosset DG, Straiton J, McDonald I, et al. Angiographic and Doppler diagnosis of cerebral artery vasospasm following subarachnoid haemorrhage. J Neurosurg. 1993;7:291–8.
Seiler RW, Grolimund P, Aaslid R, et al. Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid haemorrhage. J Neurosurg. 1986;64:594–600.
Ohta H, Ito Z. Cerebral infraction due to vasospasm, revealed by computed tomography (author’s transl). Neurol Med Chir (Tokyo). 1981;21:365–72.
Honda M, Sase S, Yokota K, Ichibayashi R, et al. Early cerebral circulatory disturbance in patients suffering subarachnoid hemorrhage prior to the delayed cerebral vasospasm stage: xenon computed tomography and perfusion computed tomography study. Neurol Med Chir (Tokyo). 2012;52:488–94.
Dolatowski K, Malinova V, Fröhlich AMJ, Schramm P, et al. Volume perfusion CT (VPCT) for the differential diagnosis of patients with suspected vasospasm: qualitative and quantitative analysis of 3d parameter maps. Eur J Radiol. 2014;83:1881–9.
Hänggi D, Turowski B, Beseoglu K, et al. Intra-arterial nimodipine for severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage: influence on clinical course and cerebral perfusion. Am J Neuroradiol. 2008;29:1053–60.
Ohtonari T, Kakinuma K, Kito T, Ezuka I, et al. Diffusion-perfusion mismatch in symptomatic vasospasm after subarachnoid hemorrhage. Neurol Med Chir (Tokyo). 2008;48:331–6.
Lee TY. Functional CT: physiological models. Trends Biotechnol. 2002;20:S3–S10.
Wintermark M, Ko NU, Smith WS, et al. Vasospasm after subarachnoid hemorrhage: utility of perfusion CT and CT angiography on diagnosis and management. Am J Neuroradiol. 2006;27:26–34.
Laslo AM, Eastwood JD, Pakkiri P, Chen F, Lee TY. CT perfusion-derived mean transit time predicts early mortality and delayed vasospasm after experimental subarachnoid hemorrhage. Am J Neuroradiol. 2008;29:79–85.
Dankbaar JW, Rijsdijk M, van der Schaaf IC, Velthuis BK, Wermer MJH, Rinkel GJE. Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Neuroradiology. 2009;51:813–9.
Conflict of Interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
Funding: No funding was received for this research.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Dietrich, C. et al. (2020). Transcranial Doppler Ultrasound, Perfusion Computerized Tomography, and Cerebral Angiography Identify Different Pathological Entities and Supplement Each Other in the Diagnosis of Delayed Cerebral Ischemia. In: Martin, R., Boling, W., Chen, G., Zhang, J. (eds) Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 127. Springer, Cham. https://doi.org/10.1007/978-3-030-04615-6_23
Download citation
DOI: https://doi.org/10.1007/978-3-030-04615-6_23
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-04614-9
Online ISBN: 978-3-030-04615-6
eBook Packages: MedicineMedicine (R0)