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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Figures

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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.

References

  • 1.

    Aaslid RMarkwalder TMNornes H: Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:7697741982Aaslid R Markwalder TM Nornes H: Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769–774 1982

    • Search Google Scholar
    • Export Citation
  • 2.

    Baker DW: Pulsed ultrasonic Doppler blood-flow sensing. IEEE Trans Sonics Ultrasonics Su-17:1701821970Baker DW: Pulsed ultrasonic Doppler blood-flow sensing. IEEE Trans Sonics Ultrasonics Su-17:170–182 1970

    • Search Google Scholar
    • Export Citation
  • 3.

    Barnes RW: Doppler ultrasonic arteriography and flow velocity analysis in carotid artery disease in Bernstein EF (ed): Noninvasive Diagnostic Techniques in Vascular Diseaseed 2. St Louis: CV Mosby1982 pp 239247Barnes RW: Doppler ultrasonic arteriography and flow velocity analysis in carotid artery disease in Bernstein EF (ed): Noninvasive Diagnostic Techniques in Vascular Disease ed 2. St Louis: CV Mosby 1982 pp 239–247

    • Search Google Scholar
    • Export Citation
  • 4.

    Blaumanis ORGrady PANelson E: Hemodynamic and morphologic aspects of cerebral vasospasm in Price TRNelson E (eds): Cerebrovascular Diseases. New York: Raven Press1979 pp 283294Blaumanis OR Grady PA Nelson E: Hemodynamic and morphologic aspects of cerebral vasospasm in Price TR Nelson E (eds): Cerebrovascular Diseases. New York: Raven Press 1979 pp 283–294

    • Search Google Scholar
    • Export Citation
  • 5.

    du Boulay GH: Angiography — the radiologist's view in Boullin DJ (ed): Cerebral Vasospasm. New York: John Wiley & Sons1980 pp 4780du Boulay GH: Angiography — the radiologist's view in Boullin DJ (ed): Cerebral Vasospasm. New York: John Wiley & Sons 1980 pp 47–80

    • Search Google Scholar
    • Export Citation
  • 6.

    Ecker ARiemenschneider PA: Arteriographic demonstration of spasm of the intracranial arteries. With special reference to saccular arterial aneurisms. J Neurosurg 8:6606671951Ecker A Riemenschneider PA: Arteriographic demonstration of spasm of the intracranial arteries. With special reference to saccular arterial aneurisms. J Neurosurg 8:660–667 1951

    • Search Google Scholar
    • Export Citation
  • 7.

    Gabrielsen TOGreitz T: Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol (Diagn) 10:1101970Gabrielsen TO Greitz T: Normal size of the internal carotid middle cerebral and anterior cerebral arteries. Acta Radiol (Diagn) 10:1–10 1970

    • Search Google Scholar
    • Export Citation
  • 8.

    Huber PHanda J: Effect of contrast material, hypercapnia, hyperventilation, hypertonic glucose and papaverine on the diameter of the cerebral arteries. Angiographic determination in man. Invest Radiol 2:17321967Huber P Handa J: Effect of contrast material hypercapnia hyperventilation hypertonic glucose and papaverine on the diameter of the cerebral arteries. Angiographic determination in man. Invest Radiol 2:17–32 1967

    • Search Google Scholar
    • Export Citation
  • 9.

    Nornes HGrip A: Hemodynamic aspects of cerebral arteriovenous malformations. J Neurosurg 53:4564641980Nornes H Grip A: Hemodynamic aspects of cerebral arteriovenous malformations. J Neurosurg 53:456–464 1980

    • Search Google Scholar
    • Export Citation
  • 10.

    Nornes HGrip AWikeby P: Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique. Part 2: Saccular aneurysms. J Neurosurg 50:5705771979Nornes H Grip A Wikeby P: Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique. Part 2: Saccular aneurysms. J Neurosurg 50:570–577 1979

    • Search Google Scholar
    • Export Citation
  • 11.

    Nornes HWikeby P: Cerebral arterial blood flow and aneurysm surgery. Part 1: Local arterial flow dynamics. J Neurosurg 47:8108181977Nornes H Wikeby P: Cerebral arterial blood flow and aneurysm surgery. Part 1: Local arterial flow dynamics. J Neurosurg 47:810–818 1977

    • Search Google Scholar
    • Export Citation
  • 12.

    Peronneau PHinglais JPellet Met al: Velocimètre sanguin par effet Doppler à émission ultrasonore pulsée. L'Onde Electr 50:3693891970Peronneau P Hinglais J Pellet M et al: Velocimètre sanguin par effet Doppler à émission ultrasonore pulsée. L'Onde Electr 50:369–389 1970

    • Search Google Scholar
    • Export Citation
  • 13.

    Phillips DJBaker DWStrandness DE Jr: Combined echo-Doppler (Duplex) imaging in Bernstein EF (ed): Noninvasive Diagnostic Techniques in Vascular Diseaseed 2. St Louis: CV Mosby1982 pp 272280Phillips DJ Baker DW Strandness DE Jr: Combined echo-Doppler (Duplex) imaging in Bernstein EF (ed): Noninvasive Diagnostic Techniques in Vascular Disease ed 2. St Louis: CV Mosby 1982 pp 272–280

    • Search Google Scholar
    • Export Citation
  • 14.

    Spencer MP: Hemodynamics of carotid artery stenosis in Spencer MPReid JM (eds): Cerebrovascular Evaluation with Doppler Ultrasound. The Hague: Martinus Nijhoff1981 pp 113131Spencer MP: Hemodynamics of carotid artery stenosis in Spencer MP Reid JM (eds): Cerebrovascular Evaluation with Doppler Ultrasound. The Hague: Martinus Nijhoff 1981 pp 113–131

    • Search Google Scholar
    • Export Citation
  • 15.

    Spencer MPReid JM: Quantification of carotid stenosis with continuous-wave (C-W) Doppler ultrasound. Stroke 10:3263301979Spencer MP Reid JM: Quantification of carotid stenosis with continuous-wave (C-W) Doppler ultrasound. Stroke 10:326–330 1979

    • Search Google Scholar
    • Export Citation

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