Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound

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✓ The use of an ultrasonic transcranial Doppler technique for noninvasive evalution of cerebral vasospasm is described. Middle cerebral arteries (MCA's), classified as spastic on angiography, demonstrated blood-flow velocity between 120 and 230 cm/sec. The flow velocities in these arteries had a clear inverse relationship to the diameter as measured from angiograms in 38 patients with recent subarachnoid hemorrhage. This relationship in the proximal anterior cerebral artery (ACA) was found to be more complicated to assess, due to the collateral channels in the anterior part of the circle of Willis. The authors conclude, however, that the new method of measuring vasospasm will also detect spasm in the ACA if it has a hemodynamically significant effect upon flow resistance.

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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    Left: Angiogram of a 46-year-old woman with aneurysm of the right internal carotid artery 7 days after subarachnoid hemorrhage. The right middle and anterior cerebral arteries were clearly spastic while those on the left side had normal caliber. Right: Spectral display of the Doppler signals from both middle cerebral arteries (MCA R and MCA L) in the same patient. The flow velocity in the right MCA was markedly elevated (150 cm/sec) when compared to 58 cm/sec measured on the left side (within normal range)

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    Left: Flow velocity in the middle cerebral arteries (MCA's) as a function of the diameter of that section of the lumen as measured on angiography. Triangles: Cases without angiographic evidence of aneurysm. Circles: Cases with aneurysms. Filled circles: Cases with aneurysms and clear angiographic evidence of vasospasm. The dotted line, y = 55 + 167/x2, was found by nonlinear regression analysis of the entire series. The correlation was r = 0.75. Right: Flow velocity in the anterior cerebral artery (ACA) as a function of the diameter of that section of the lumen as measured on angiography. Symbols as in left. The numbers refer to cases discussed in the text; “1” signifies the patient shown in Fig. 1, “2” indicates a case of bilateral ACA spasm, and “3” a case with one hypoplastic ACA.

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