The role of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage

Deb, Smita; Gogos, Andrew; Drummond, Katharine J.; Teddy, Peter J.

doi:10.1016/j.jocn.2011.12.001

Cited by 10 publications

(8 citation statements)

References 20 publications

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“…22,45 Furthermore, the clinical value of TCD has been questioned. 46 Our finding that neither ADMA, arginine, or arginine:ADMA was related to V MCA is in line with previous findings, though they are limited in numbers. 19,21,47 Biological explanations may be that first, systemic ADMA is not a reflection of intracellular concentrations; second, the plasma ADMA is too low in concentration to limit arginine transport; 48 and third, the effect of ADMA may be on the microvascular level in reducing blood flow.…”

supporting

confidence: 92%

Low Plasma Arginine:Asymmetric Dimethyl Arginine Ratios Predict Mortality After Intracranial Aneurysm Rupture

Staalsø

Bergström²,

Edsen³

et al. 2013

Stroke

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Background-Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthases, predicts mortality in cardiovascular disease and has been linked to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). In this prospective study, we assessed whether circulating ADMA, arginine:ADMA ratio, and nitrite/nitrate levels were associated with survival and cerebral vasospasm in SAH patients. Methods-One hundred and eleven patients were observed day 1 to 15 after SAH, with serial measurements of transcranial Doppler flow velocities (V MCA ) and plasma biomarkers. Clinical status was assessed by the World Federation of Neurosurgical Societies grading scale. Results-Overall 30-day mortality was 18%, but differed between patients grouped by low, midrange, and high arginine:ADMA ratio in the first week after SAH. Mortality rates were 14/37, 1/37, and 5/37 in the 3 groups, respectively (P-logrank=0.0003). Cox regression showed that low versus midrange or high arginine:ADMA was associated with a hazard ratio of 4.1 independent of World Federation of Neurosurgical Societies grade (95% confidence interval, 1.5-10.9; P=0.006). ADMA or arginine:ADMA had no association to V MCA , but there was an inverse relationship between V MCA and nitrite/nitrate levels (P<0.0001). The NOS3 894G/G genotype was associated with 15% lower V MCA (P=0.01). ATbG-NOS3 haplotype homozygosity was associated with up to 64% higher nitrite/nitrate levels (P=0.003). Conclusions-This

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supporting

confidence: 92%

Low Plasma Arginine:Asymmetric Dimethyl Arginine Ratios Predict Mortality After Intracranial Aneurysm Rupture

Staalsø

Bergström²,

Edsen³

et al. 2013

Stroke

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“…Also PW-CT failed to detect perfusion deficits at the same time. The interpretation of measured elevated blood flow velocities by TCD is controversial concerning radiological and symptomatic CVS, as already discussed in other studies [14, 15]. This case illustrated pointedly the diagnostic value of NIRS for early detection of DCI in a sedated and intubated patient.…”

Section: Discussionmentioning

confidence: 53%

“…As a noninvasive measurement tool one or two channel EEG adhesive electrodes are used to monitor the sedation depth [2, 11–13]. As another noninvasive but discontinuous bedside measurement method transcranial Doppler (TCD) is also available, with well-known deficits like investigator dependence and weak correlation of elevated blood flow velocity and symptomatic CVS [14, 15]. …”

Section: Introductionmentioning

confidence: 99%

Continuous Measurement of Cerebral Oxygenation with Near-Infrared Spectroscopy after Spontaneous Subarachnoid Hemorrhage

et al. 2012

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Objective. The aim of our prospective study was to investigate the applicability and the diagnostic value of near-infrared spectroscopy (NIRS) in SAH patients using the cerebral oximeter INVOS 5100C. Methods. Measurement of cerebral oximetry was done continuously after spontaneous SAH. Decrease of regional oxygen saturation (rSO2) was analyzed and interpreted in view of the determined intrinsic and extrinsic factors. Changes of rSO2 values were matched with the values of ICP, tipO2, and TCD and the results of additional neuroimaging. Results. Continuous measurement of rSO2 was performed in nine patients with SAH (7 females and 2 males). Mean measurement time was 8.6 days (range 2–12 days). The clinical course was uneventful in 7 patients without occurrence of CVS. In these patients, NIRS measured constant and stable rSO2 values without relevant alterations. Special findings are demonstrated in 3 cases. Conclusion. Measurement of rSO2 with NIRS is a safe, easy to use, noninvasive additional measurement tool for cerebral oxygenation, which is used routinely during vascular and cardiac surgical procedures. NIRS is applicable over a long time period after SAH, especially in alert patients without invasive probes. Our observations were promising, whereby larger studies are needed to answer the open questions.

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“…The transcranial Doppler ultrasound (TCD) is a portable and efficient tool for determining cerebral blood flow and has become the most widely used technique for evaluating cerebral vasospasm in the neurocritical care unit [9]. In a meta-analysis by Lysakowski et al [10], TCD reliably predicted proximal middle cerebral artery (MCA) spasm in 97% of SAH patients.…”

Section: Surveillance Instrumentsmentioning

confidence: 99%

Evidence-Based Cerebral Vasospasm Surveillance

Kistka

Dewan

Mocco

2013

Neurology Research International

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Subarachnoid hemorrhage related to aneurysmal rupture (aSAH) carries significant morbidity and mortality, and its treatment is focused on preventing secondary injury. The most common—and devastating—complication is delayed cerebral ischemia resulting from vasospasm. In this paper, the authors review the various surveillance technologies available to detect cerebral vasospasm in the days following aSAH. First, evidence related to the most common modalities, including transcranial doppler ultrasonography and computed tomography, are reviewed. Continuous electroencephalography and older instruments such as positron emission tomography, xenon-enhanced CT, and single-photon emission computed tomography are also discussed. Invasive strategies including brain tissue oxygen monitoring, microdialysis, thermal diffusion, and jugular bulb oximetry are examined. Lastly, near-infrared spectroscopy, a recent addition to the field, is briefly reviewed. Each surveillance tool carries its own set of advantages and limitations, and the concomitant use of multiple modalities serves to improve diagnostic sensitivity and specificity.

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The role of transcranial Doppler ultrasound monitoring in patients with aneurysmal subarachnoid haemorrhage

Cited by 10 publications

References 20 publications

Low Plasma Arginine:Asymmetric Dimethyl Arginine Ratios Predict Mortality After Intracranial Aneurysm Rupture

Low Plasma Arginine:Asymmetric Dimethyl Arginine Ratios Predict Mortality After Intracranial Aneurysm Rupture

Continuous Measurement of Cerebral Oxygenation with Near-Infrared Spectroscopy after Spontaneous Subarachnoid Hemorrhage

Evidence-Based Cerebral Vasospasm Surveillance

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