Usefulness of TCD on Prediction for Symptomatic Vasospasm in Early Stage of Ruptured Cerebral Aneurysm

Abstract

Is it possible for the estimation of MCA flow velosity (FV) and regional cerebral blood flow to predic delayed Ischemic Neuronal Deficits (DIND) following ruputured cerebral aneurysm?This series consists of 41 patients with ruptured cerebral aneurysms who received emergency operations within 48 hours after onset. 26 rCBF measurements were performed and 16 were carried out within 7days after onset. TCD was measured everyday until 25th day after onset. All patients had CT scan, cerebral angiogram and neurological assessment upon admission. To clarify morphological changes of cerebral vessels due to sabarachnoid hemorrhage, the second angiogram was performed about lOdays after operation.Results : DIND appeared when mean rCBF decreased below 50 ml/100gbrain/min. There was no correlation between mean rCBF within 7days after onset and Hunt-Kosnik grade on admission, however, there was a good correlation of mean rCBF and CT classification on admission.15 patients with DIND had a rapid increase of FV from the 3rd to 5th day after onset and continued high flow velosity more than 150cm/s during 6days on average after rapid increase of FV. On the other hand, 26 patients without DIND showed only small increase of FV, less than 11Ocm/s There was a correlation between % changesof FV increase during 3rd to 5th days and morphological types of cerebral vasospasm. More than 30 % FV increase were maintained 2days in the patients with diffuse severe-type spasm.There was a good relationship between mean rCBF and FV of MCA, and also MCA diameter (ratio of vasospasm) and MCAFV.Conclusion : The prediction of DIND could be done 51 % on CT findings of admission and 88 % on serial measurements of MACFV.) The predictability of the rCBF value was not dependent on the reversibility of the vasospasm symptons.