Predictive Value of Mean Flow Velocity by TCD in Early Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage
Predictive Value of Mean Flow Velocity by TCD in Early Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage
Aim of this work is to evaluate the transcranial doppler in prediction of cerebral vasospasm
 in aneurysmal subarachnoid hemorrhage and also to evaluate their advantages over clinical
 scales in predicting CV.
Cerebral vasospasm is defined as narrowing of a cerebral blood vessel enough to cause
 reduction in distal blood flow. Seventy percent of aSAH patients develop angiographic
 vasospasm but only 30% progress to develop evident neurological deficits. Cerebral vasospasm
 may be asymptomatic with no clinical symptoms and signs but only abnormal investigations,
 such as vascular stenosis by angiography or high blood flow speed by Doppler ultrasound.

 Standard tests used to determine the source of bleeding and diagnose cerebral vasospasm (CV)
 include neuroimaging studies that administer contrast either intravenously (computed
 tomography angiography [CTA]) or intra-arterially (digital subtraction angiography [DSA]).
 Cerebral blood flow measurements using computed tomography (CT) perfusion techniques may
 detect the degree of cerebral ischemia in a very early stage. Although well-tolerated, these
 studies cannot be readily performed on the bedside and expose the patient to additional
 radiation, thus significantly restricting their use in daily cerebral hemodynamics
 monitoring. Moreover, they involve patient transportation to the CT scanner and utilization
 of resources such as nurses, technologists, and ancillary personnel.

 Early detection of cerebral vasospasm is an important step in the way of the improvement of
 the outcome and the survival of aSAH patients. Transcranial duplex (TCD) is a non-invasive
 modality which can assess the cerebral blood vessels diameters and flow velocities that can
 be a useful maneuver in early detection of vasospasm after aSAH
Inclusion Criteria:

 -  Adult patients diagnosed with spontaneous aneurysmal SAH diagnosed by non-contrast
 brain CT scan at the onset and confirmed by CT angiography within 72 hours of onset
 were included

 Exclusion Criteria:

 -  Patient with previous history of disabling brain injuries causing focal neurological
 signs (e.g. motor weakness).

 -  Patients with poor temporal TCD window required for bedside evaluation of CV.

 -  Patients with decompensated systemic illness like hepatic, renal and cardiac were
 excluded.

 -  Patients with deep coma (GCS<6) were excluded.