Skip to main content
SpringerLink
Log in

Vasospasm diagnosis: Theoretical and real transcranial Doppler sensitivity

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

In 40 patients middle cerebral artery trunk (M1) flow velocity was recorded just before 54 carotid angiography in 54 cases exhibiting vasospasm after aneurysm rupture. Angiographic vasospasm distribution was studied; cases of symptomatic vasospasm were noted and were compared with transcranial Doppler data. Angiographic vasospasm was present in M1 in 41/54 carotid angiograms.

Postulating that all the cases of M1 angiographic vasospasm should be identified by transcranial Doppler, the theoretical sensitivity of TCD was 76%. In this series however the real sensitivity of TCD in vasospasm diagnosis was only 70%: besides 13 cases where vasospasm was not present in M1 (mainly after ACoA Aneurysm rupture), TCD failed to identify 3 cases of M1 angiographic vasospasm. Vasospasm may not be located in M1 even when severe and symptomatic (4 cases in this series).

Transcranial Doppler remains a mediocre tool for identifying vasospasm after anterior communicating artery aneurysm rupture (sensitivity: 55%). Its reliability is better after internal carotid aneurysm rupture (sensitivity: 72%) and excellent after middle cerebral artery aneurysm rupture (sensitivity: 93%).

In order to test the drugs or methods used to prevent or combat vasospasm, angiography has to be considered when during the vasospasm risk period TCD does not demonstrate vasospasm in M1, either in patients in whom clinical deterioration is occurring without other obvious explanation, or in all patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Creissard P, Rabehenoina CH, Sevrain L, Freger P, Hattab N, Tadie M, Clavier E, Thiebot J, Laissy JP (1990) Intérêt du Scanner et de l'Artériographie de contrôle dans l'étude des résultats de la chirurgie anévrismale. Une série de 100 cas consécutifs. Neurochirurgie 36: 209–217

    PubMed  Google Scholar 

  2. Creissard P, Proust F (1994) Vasospasm diagnosis: theoretical sensitivity of transcranial Doppler estimated from 135 angiographies demonstrating vasospasm. Practical consequences. Acta Neurochir (Wien) 131: 12–18

    Google Scholar 

  3. Ducrocq X, Girard A, Auque J, Marchal JC, Burdin D, Pincemaille B, Lepoire J, Hepner H (1989) Intérêt du Doppler transcrânien au cours de la surveillance des hëmorrgies méningées anévrismales traitées par inhibiteurs calciques. Agressologie 7: 425–430

    Google Scholar 

  4. Grosset DG, Straiton J, Du Trevou M, Bullock R (1992) Prediction of symptomatic Vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes. Stroke 23: 674–679

    PubMed  Google Scholar 

  5. Grosset DG, Straiton J, McDonald I, Cockburn M, Bullock R (1993) Use of transcranial Doppler sonography to predict development of a delayed ischemic deficit after subarachnoid hemorrhage. J Neurosurg 78: 183–187

    PubMed  Google Scholar 

  6. Harders AG, Gilsbach JM (1987) Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound. J Neurosurg 66: 718–728

    PubMed  Google Scholar 

  7. Hutchison K, Weir B (1989) Transcranial Doppler studies in aneurysm patients. Can J Neurol Sci 16: 411–416

    PubMed  Google Scholar 

  8. Kaech DL, Despland PA, de Tribolet N (1990) Le Doppler transcrânien dans l'évaluation des vasospasmes après hémorragie sous-arachnoïdienne. Neurochirurgie 36: 279–286

    PubMed  Google Scholar 

  9. Laumer R, Steinmeier R, Gönner F, Vogtmann T, Priem R, Fahlbusch R (1993) Cerebral hemodynamics in subarachnoid hemorrhage evaluated by transcranial Doppler sonography. Part 1. Reliability of flow velocities in clinical management. Neurosurgery 33: 1–9

    PubMed  Google Scholar 

  10. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1989) Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 100: 12–24

    Google Scholar 

  11. Newell DW, Winn R (1990) Transcranial Doppler in cerebral vasospasm. Neurosurg Clin N Am 1: 319–328

    PubMed  Google Scholar 

  12. Newell DW, Aaslid R (1992) Transcranial Doppler: clinical and experimental uses. Cerebrovasc Brain Metab Rev 4: 122–143

    PubMed  Google Scholar 

  13. Romner B, Ljunggren B, Brandt L, Söveland H (1989) Transcranial Doppler sonography within 12 hours after subarachnoid hemorrhage. J Neurosurg 70: 732–736

    PubMed  Google Scholar 

  14. Romner B, Ljunggren B, Brandt L, Säveland H (1990) Correlation of transcranial Doppler sonography findings with timing of aneurysm surgery. J Neurosurg 73: 72–76

    PubMed  Google Scholar 

  15. Seiler RW, Grolimund P, Aaslid R, Huber P, Nornes H (1986) Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage. J Neurosurg 64: 594–600

    PubMed  Google Scholar 

  16. Sloan MA, Haley EC, Kassell NF, Henry ML, Stewart SR, Beskin RR, Sevilla EA, Torner JC (1989) Sensitivity and specifity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage. Neurology 39: 1514–1518

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Centre Hospitalier Universitaire, Rouen, France

    P. Creissard, F. Proust & O. Langlois

Authors
  1. P. Creissard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Proust
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Langlois
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Creissard, P., Proust, F. & Langlois, O. Vasospasm diagnosis: Theoretical and real transcranial Doppler sensitivity. Acta neurochir 136, 181–185 (1995). https://doi.org/10.1007/BF01410623

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01410623

Keywords

Search

Navigation