Transcranial Doppler Monitoring in Subarachnoid Hemorrhage

Park, Soo-Hyun; Kim, Tae Jung; Ko, Sang‐Bae

doi:10.31728/jnn.2022.00115

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…Prior studies suggested TCD parameters for ACA or iICA that differ from MCA TCD parameters. 13,14 By applying consistent criteria for multiple vessels, a broader picture of cerebrovascular blood flow dynamics can be captured, leading to more comprehensive evaluation of vasospasm. This approach also simplifies the interpretation process, facilitating a more streamlined and efficient analysis of TCD data.…”

Section: Discussionmentioning

confidence: 99%

“…In the case where a patient experiences vasospasm solely in the ACA, the MFV of the MCA may not adequately reflect this condition. Prior studies suggested TCD parameters for ACA or iICA that differ from MCA TCD parameters 13,14 . By applying consistent criteria for multiple vessels, a broader picture of cerebrovascular blood flow dynamics can be captured, leading to more comprehensive evaluation of vasospasm.…”

Section: Discussionmentioning

confidence: 99%

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The TCD hyperemia index to detect vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage

Kim

Mehta

Nair

et al. 2023

Journal of Neuroimaging

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Background and PurposeElevated mean flow velocity (MFV) on transcranial Doppler (TCD) is used to predict vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Hyperemia should be considered when observing elevated MFV. Lindegaard ratio (LR) is commonly used but does not enhance predictive values. We introduce a new marker, the hyperemia index (HI), calculated as bilateral extracranial internal carotid artery MFV divided by initial flow velocity.MethodsWe evaluated SAH patients hospitalized ≥7 days between December 1, 2016 and June 30, 2022. We excluded patients with nonaneurysmal SAH, inadequate TCD windows, and baseline TCD obtained after 96 hours from onset. Logistic regression was conducted to assess the significant associations of HI, LR, and maximal MFV with vasospasm and delayed cerebral ischemia (DCI). Receiver operating characteristic analyses were employed to find the optimal cutoff value for HI.ResultsLower HI (odds ratio [OR] 0.10, 95% confidence interval [CI] 0.01‐0.68), higher MFV (OR 1.03, 95% CI 1.01‐1.05), and LR (OR 2.02, 95% CI 1.44‐2.85) were associated with vasospasm and DCI. Area under the curve (AUC) for predicting vasospasm was 0.70 (95% CI 0.58‐0.82) for HI, 0.87 (95% CI 0.81‐0.94) for maximal MFV, and 0.87 (95% CI 0.79‐0.94) for LR. The optimal cutoff value for HI was 1.2. Combining HI <1.2 with MFV improved positive predictive value without altering the AUC value.ConclusionsLower HI was associated with a higher likelihood of vasospasm and DCI. HI <1.2 may serve as a useful TCD parameter to indicate vasospasm and DCI when elevated MFV is observed, or when transtemporal windows are inadequate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The TCD hyperemia index to detect vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage

Kim

Mehta

Nair

et al. 2023

Journal of Neuroimaging

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“…However, one of the most common indications for the use of TCD monitoring is the evaluation of vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). Symptomatic vasospasm develops in 20–40% of patients with aneurysmal SAH and remains the leading cause of morbidity and mortality in this patient population ( 31 ). Diagnostic cerebral angiography remains the gold standard for detecting vasospasm, but it is an invasive procedure, which limits its usefulness for dynamic monitoring.…”

Section: Modalitiesmentioning

confidence: 99%

Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty

et al. 2023

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With the advancements in modern medicine, new methods are being developed to monitor patients in the intensive care unit. Different modalities evaluate different aspects of the patient's physiology and clinical status. The complexity of these modalities often restricts their use to the realm of clinical research, thereby limiting their use in the real world. Understanding their salient features and their limitations can aid physicians in interpreting the concomitant information provided by multiple modalities to make informed decisions that may affect clinical care and outcomes. Here, we present a review of the commonly used methods in the neurological intensive care unit with practical recommendations for their use.

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Vasospasm in traumatic brain injury

Carqueja,

Silva,

Albuquerque

et al. 2024

BMJ Case Rep

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Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in young individuals. Management of TBI is complex and aims to prevent secondary injury and optimise conditions for neurological recovery. Vasospasm is a possible complication of TBI, and its significance is unknown. Its incidence is underestimated and there are currently no preventive or therapeutic approaches with proven efficacy. The occurrence of vasospasm contributes to secondary brain injury and worsens prognosis. The diagnosis of vasospasm in TBI is challenging due to the difficulty in perceiving neurological deterioration in these patients. We present a case of a young patient admitted to the neurocritical care unit following TBI. He presented a partial neurological recovery, followed by clinical deterioration and persistent coma. The diagnosis of extensive ischaemic lesions due to severe vasospasm was established. Suspicion of vasospasm and timely screening, particularly in high-risk patients, may improve survival and outcomes in TBI.

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Transcranial Doppler Monitoring in Subarachnoid Hemorrhage

Cited by 4 publications

References 45 publications

The TCD hyperemia index to detect vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage

The TCD hyperemia index to detect vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage

Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty

Vasospasm in traumatic brain injury

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