Abstract
Clinical vasospasm, or delayed ischemia-related neurologic deficits, is the prime determinant of morbidity and mortality after subarachnoid hemorrhage. The diagnosis of clinical vasospasm has been based mainly on clinical observations. Noninvasive techniques for evaluating vasospasm have great promise in supplementing the detailed neurologic examination and assessing the effects of therapy. The clinical utility of single-photon emission computed tomography (SPECT) of regional cerebral blood flow and transcranial Doppler ultrasound (TCD) in the evaluation of cerebral vasospasm after subarachnoid hemorrhage was reviewed in 40 patients. The combination of these noninvasive tests was valuable for the investigation of the dynamic anatomic and functional aspects of vasospasm. TCD proved helpful in monitoring for vascular narrowing by measurements of blood flow velocity. Brain SPECT ascertained the effects of vasospasm on regional cerebral blood flow. In the diagnosis of clinical vasospasm, or delayed ischemic deficits, brain SPECT was more sensitive and specific than TCD. The combination of SPECT and TCD was useful in the assessment of the effect of cerebral angioplasty on hemodynamics and perfusion in the attempt to avert infarction.
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