Cerebral Hemodynamics in Subarachnoid Hemorrhage Evaluated by Transcranial Doppler Sonography. Part 1. Reliability of Flow Velocities in Clinical Management
| Autor: | Friedrich Gönner, Ralf Steinmeier, Rudolf Laumer, Thomas Vogtmann, Rudolf Fahlbusch, Ralf Priem |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Adult
Subarachnoid hemorrhage Adolescent Hemodynamics Severity of Illness Index Brain Ischemia Severity of illness Humans Medicine Prospective Studies Child Prospective cohort study Nimodipine Aged Ultrasonography Aged 80 and over Rupture Spontaneous business.industry Vascular disease Intracranial Aneurysm Vasospasm Cerebral Arteries Middle Aged Subarachnoid Hemorrhage medicine.disease Combined Modality Therapy Transcranial Doppler Ischemic Attack Transient Cerebrovascular Circulation Child Preschool Anesthesia Female Surgery Neurology (clinical) business Blood Flow Velocity medicine.drug |
| Zdroj: | Neurosurgery. 33:1-9 |
| ISSN: | 0148-396X |
| Popis: | During recent years, the management of subarachnoid hemorrhage (SAH) has changed, resulting in an increase in early operations and routine administration of nimodipine. Both influenced the indication for transcranial Doppler sonography (TCD). Furthermore, investigations detected discrepancies between Doppler findings and neurological status. In a prospective study, the reliability of TCD was investigated in patients with SAH treated with intravenously administered nimodipine. Patients with large hematomas were excluded. Neurological deficits immediately after surgery or within the first 48 hours were classified as not delayed, and therefore not necessarily due to vasospasm. The most remarkable points of this study are that there is no significant difference between the flow velocities for Hunt and Hess Grades I and II when compared with those for Grade III, and that Grades IV and V seem to be affiliated with the lowest velocities. When the flow velocities of 11 patients who developed delayed ischemic deficits (DIDs) were compared with those of patients with no deficit, no significant difference was seen. A significant increase in velocity in the days before the onset of DID was found only in 3 of 11 cases. Eight patients showed either constant high or constant low velocities or even, in some cases, decreasing time courses. High flow velocities did not necessarily mean impending neurological deficits: 8 of 66 patients tolerated flow velocities over 200 cm/s. Therefore, it no longer seems to be justified to proclaim that TCD is able to predict neurological deficits, although it is doubtless able to detect vasospasm.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|