• Medicina intensiva · Dec 2012

    Observational Study

    [Emergency transcranial doppler ultrasound: predictive value for the development of symptomatic vasospasm in spontaneous subarachnoid hemorrhage in patients in good neurological condition].

    • M A Muñoz-Sanchez, F Murillo-Cabezas, J J Egea-Guerrero, M L Gascón-Castillo, P Cancela, R Amaya-Villar, M D Rincón-Ferrari, J M Flores-Cordero, A Cayuela, and C García-Alfaro.
    • UGC, Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
    • Med Intensiva. 2012 Dec 1;36(9):611-8.

    PurposeTo examine the predictive value of an early transcranial Doppler ultrasound (TCD) study performed in the emergency department in patients with spontaneous subarachoniod hemorrhage (SAH) in good neurological condition, in order to know which patients are at high risk of developing delayed cerebral ischemia (DCI).DesignA descriptive observational study was carried out involving a period of 3 years.SettingCritical Care and Emergency Department.PatientsThe study consecutively included patients with SAH of grade I-III on the Hunt and Hess scale.Variables Of InterestDCI (decrease of 2 points in GCS or focal deficit), Mean Velocity (MV) of middle cerebral arteries (MCA), Lindegaard Index (IL). Sonographic vasospasm pattern (SVP) was considered if MCA-MV>120cm/sc and IL>3.ResultsThe mean age of the 122 patients was 54.1±13.7 years; 57.3% were women. SVP was detected in 24 patients (19.7%), although high velocities patterns (HVP) were present in 38 patients (31.1%). DCI developed in 21 patients (MV183+/-49cm/sc), all with previous SVP. In this group MV increased 22+/-5cm/sc/day during the first 3 days. The group without HVP (84 patients/MV of 67+/-16.6cm/sc), compared with DCI group, showed differences in highest MV (p<0.001), and also ΔMV/day (8.30+/-4,5cm/sc Vs 22+/-5cm/sc) during the first 3 days (p=0.009). In our series, ROC analysis selected the best cut-off value for ΔMV/day as 21cm/sc (p<0.001).ConclusionDuring the first 3 days, an increase of 21cm/s/24h in MCA-MV was associated with the development of symptomatic vasospasm. TCD is a useful tool for the early detection of patients at risk of DCI after SAH.Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

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