Musical murmurs in human cerebral arteries after subarachnoid hemorrhage

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✓ A transcranial ultrasonic method for the recording of murmurs from cerebral vessels is described. Using the new approach the authors have observed musical murmurs of pure tone quality in 15 patients with increased flow velocities in the cerebral arteries after spontaneous subarachnoid hemorrhage (SAH). The frequency range of the pure tones was from 140 to 820 Hz, corresponding to flow velocities between 73 and 215 cm/sec. The musical murmurs occurred as a transitional state between silent flow and the well known phenomenon of bruit. They were observed between the 4th and the 20th day after SAH. The most likely cause of the musical murmur is a periodic shedding of vortices in the cerebral arteries, commonly referred to as “a von Kármán vortex street.” Clinically the presence of musical murmurs indicated that pathologically increased blood velocities were present in the artery under investigation. This probably reflected the degree of spasm.

Article Information

Address reprint requests to: Rune Aaslid, Ph.D., Department of Neurosurgery, National Hospital, Rikshospitalet, Oslo, Norway.

© AANS, except where prohibited by US copyright law.

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Figures

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    Spectral display of the musical murmur (lower) and the Doppler signal (upper) from Case 2. The recordings were made from the right middle cerebral artery, slightly distal of the bifurcation of the internal carotid artery. Three sound modes are recognized in the lower tracing: A systolic bruit (1), a musical murmur displayed as a narrow band in early diastole (2), and a silent phase in late diastole (3). The second harmonic of the musical murmur is also seen in the recording, this is probably an artifact from the ultrasonic modulation/demodulation process.

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    Case 1. A: Spectral display of the musical murmurs (lower) and the Doppler signal (upper) in the region where the right internal carotid artery divides into the middle and anterior cerebral arteries. The musical murmur had a relatively constant frequency in systole. The diastole was silent. B: High-resolution (16 Hz) spectral analysis of the musical murmur in mid-systole. The pure tone quality is seen as a narrow spectral line at 560 Hz.

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    The relationship between the velocity of the blood flow and the fundamental frequency of the musical murmur in this series of patients (excluding Case 13). Each case is represented by two points connected with a line indicating the range of frequencies and velocities observed. The dotted line, y = − 4 + 2.35 ×, is found by regression analysis of all points: r = 0.74.

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