Cerebral Vasospasm After Subarachnoid Haemorrhage Investigated by Means of Transcranial Doppler Ultrasound

Summary

Measurements of flow velocity in defined segments of the basal cerebral arteries can be obtained through the intact adult skull using 2 MHz pulsed Doppler ultrasound. We compared flow velocity in these vessels with findings from 56 cerebral angiographies obtained in 51 patients at from day 1 to day 21 after subarachnoid haemorrhage (SAH). The diameter of the proximal segment of the middle cerebral, anterior cerebral, and posterior cerebral arteries (MCA, ACA, and PCA, respectively) were measured from anteroposterior films produced in one angiographie laboratory. In patients investigated on day 1–2, the median MCA diameter was 2.8 mm with range 2.3-3.4 mm. The median flow velocity was 56 cm/s, range 36–88 cm/s (within normal limits). There was a clear inverse relationship between the MCA diameter and MCA flow velocity. Eleven of the 13 MCA’s having diameter 1.5 mm or less showed flow velocity in excess of 140 cm/s. This seems a useful limit to diagnose pronounced MCA spasm (50% diameter reduction) with this method. Further clues to the severity of MCA spasm were obtained from the ratio calculated dividing the MCA flow velocity by the flow velocity in the ipsilateral, extracranial internal carotid artery (ICA), since spasm probably does not involve the neck vessels. This ratio was from 1.1 to 2.3, median 1.7 at day 1–2, but rose to over 10 in patients with the most severe MCA lumen narrowing.

The PCA flow velocity was inversely related to the PCA diameter.

Assessment of ACA spasm requires considering findings from both hemispheres combined, since the two proximal ACA’s usually anastomose through the anterior communicating artery. Therefore, and ACA spasm or developmental anomaly notwithstanding, the larger ACA showed the higher flow velocity in 17 of the 22 patients with a clear asymmetry of the circle of Willis.