The “spasm score” on TCD Examination in the Patients with Vasospasms after Subarachnoid Hemorrhage.

Abstract

TCD examination was performed in 71 patients with subarachnoid hemorrhage secondary to ruptured intracranial aneurysm. Delayed ischemic neurological deficits (DIND) accompanying vascular spasms were detected in 17 patients, but 10 of these recovered from the DIND within about 3 weeks. The TCD findings could be classified into four types according to their mean blood flow velocities (MBFV) . They consisted of: a) high pattern type, in which the MBFV had increased more than 100 cm/s (29 cases), b) low pattern type, in which the MBFV was less than 45cm/s (7cases), c) paradoxical pattern type, in which the MBFV was faster in the more peripheral regions (5 cases), and d) normal pattern type (30 cases) . From observation of the Doppler frequency, the sound of signals, and displayed waveforms, six characteristic findings were evaluated. (1) Filling-in of the systolic windows was observed in 16 out of 17 cases with DIND (23 out of 54 cases without DIND), (2) appearance of negative flow components was noted in all of the DIND cases (18 cases), (3) contour oscillation was viewed in 14 cases (10 cases), (4) high-intensity frequency was seen in 12 cases (14 cases), (5) musical murmur was heard in 8 cases (9 cases), and (6) disappearance of pulsatility was seen in 11 cases (10 cases) . From the observation of these six components, we made a“spasm score”on the TCD records. The score was 5.18±1.54 in the 17 patients with DIND, and 2.39±2.41 in 54 patients without DIND (p<0.001) . Sixteen patients out of 31 patients who had a spasm score of more than 3 suffured DIND, whereas, only one patient with a spasm score of less than 2 had DIND (p<0.01) . Hence this spasm score seemed to be very useful in the diagnosis of DIND in patients with vasospasms.