992: Comparison of Sedative Regimens in Patients With Vasospasm With Subarachnoid Hemorrhage

Bast, Chelsea; Liu, Mimi; Faris, J. Edwin

doi:10.1097/01.ccm.0000642904.80056.19

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“…Aneurysmal subarachnoid hemorrhage (aSAH) carries a risk for cerebral vasospasm (CV), which causes reduced cerebral blood flow and delayed ischemic injury. 1 Around 5.5 per 100,000 persons per year experience subarachnoid hemorrhage. 2 About 20% to 30% of patients with aSAH develop delayed cerebral ischemia (DCI) caused by CV.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of the transcranial Doppler and mean arterial flow velocity for early detection of cerebral vasospasm in aneurysmal subarachnoid hemorrhage

Esmael

Flifel

Elmarakby³

et al. 2020

Ultrasound

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Objectives We aimed to predict cerebral vasospasm in acute aneurysmal subarachnoid hemorrhage and to determine the cut-off values of the mean flow velocity by the use of transcranial Doppler. Methods A total of 40 patients with acute aneurysmal subarachnoid hemorrhage were included in this study and classified into two groups. The first group was 26 patients (65%) with cerebral vasospasm and the second group was 14 patients (35%) without vasospasm. Initial evaluation using the Glasgow Coma Scale and the severity of aneurysmal subarachnoid hemorrhage was detected by using both the clinical Hunt and Hess and radiological Fisher grading scales. All patients underwent transcranial Doppler evaluations five times in 10 days measuring the mean flow velocities (MFV) of cerebral arteries. Results Patients with cerebral vasospasm were associated with significantly higher mean Glasgow Coma Scale score ( p = 0.03), significantly higher mean Hunt and Hess scale grades ( p = 0.04), with significantly higher mean diabetes mellitus ( p = 0.03), significantly higher mean systolic blood pressure and diastolic blood pressure ( p = 0.02 and p = 0.005 respectively) and significantly higher MFVs measured within the first 10 days. Logistic regression analysis demonstrated that MFV ≥81 cm/s in the middle cerebral artery is accompanied by an almost five-fold increased risk of vasospasm (OR 4.92, p < 0.01), while MFV ≥63 cm/s in the anterior cerebral artery is accompanied by a three-fold increased risk of vasospasm (OR 3.12, p < 0.01), and MFV ≥42 cm/s in the posterior cerebral artery is accompanied by a two-fold increased risk of vasospasm (OR 2.11, p < 0.05). Conclusion Transcranial Doppler is a useful tool for early detection, monitoring, and prediction of post subarachnoid vasospasm and valuable for early therapeutic intervention before irreversible ischemic neurological deficits take place.

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Section: Introductionmentioning

confidence: 99%