The use of transcranial Doppler ultrasonography in early outcome prediction of patients with subarachnoid hemorrhage

Introduction

Transcranial Doppler ultrasonography (TCD) is a well-established technique for detection of cerebral vasospasm in patients with subarachnoid hemorrhage (SAH). The aim of our study is to investigate whether there is a relationship between TCD findings during the first 3 days after admission and the neurological outcome of patients.

Materials and methods

Sixty-seven patients (60 ± 12.9 years, APACHE II score 18.2 ± 6.4) were included in our study. TCD middle cerebral artery systolic (SV), diastolic, and mean flow velocities and pulsatility index (PI) were measured daily following SAH. Neurological evaluation was performed at ICU discharge using the Glasgow Outcome Score (GOS). A GOS score of 1–3 was considered a pure outcome (group 1, n = 56), a GOS score of 4 or 5 as a good outcome (group 2, n = 11). The Student t test was used to compare the data and P < 0.05 was considered significant.

Results

See Table 1. At admission there was no statistically significant difference between the two groups in their flow velocities and PI. The patients with pure outcome (group 1) exhibited higher systolic flow velocities and higher PI on day 3 after admission.

Table 1 TCD findings during the first 3 days after SAH (mean ± standard deviation)

Conclusion

The elevation of PI and systolic flow velocity on day 3 after admission seems to be related to pure neurological outcome of patients suffering SAH probably due to early appearance of vasospasm.