Back to Search
Start Over
Posttraumatic cerebral arterial spasm: transcranial Doppler ultrasound, cerebral blood flow, and angiographic findings.
- Source :
-
Journal of neurosurgery [J Neurosurg] 1992 Oct; Vol. 77 (4), pp. 575-83. - Publication Year :
- 1992
-
Abstract
- Thirty patients admitted after suffering closed head injuries, with Glasgow Coma Scale scores ranging from 3 to 15, were evaluated with transcranial Doppler ultrasound monitoring. Blood flow velocity was determined in the middle cerebral artery (MCA) and the intracranial portion of the internal carotid artery (ICA) in all patients. Because proximal flow in the extracranial ICA declines in velocity when arterial narrowing becomes hemodynamically significant, the extracranial ICA velocity was concurrently monitored in 19 patients. To assess cerebral perfusion, cerebral blood flow (CBF) measurements obtained with the intravenous 133Xe technique were completed in 16 patients. Vasospasm, designated as MCA velocity exceeding 120 cm/sec, was found in eight patients (26.7%). Severe vasospasm, defined as MCA velocity greater than 200 cm/sec, occurred in three patients, and was confirmed by angiography in all three. Subarachnoid hemorrhage (SAH) was documented by computerized tomography in five (62.5%) of the eight patients with vasospasm. All cases of severe vasospasm were associated with subarachnoid blood. The time course of vasospasm in patients with traumatic SAH was similar to that found in patients with aneurysmal SAH; in contrast, arterial spasm not associated with SAH demonstrated an uncharacteristically short duration (mean 1.25 days), suggesting that this may be a different type of spasm. A significant correlation (p less than 0.05) was identified between the lowest CBF and highest MCA velocity in patients during the period of vasospasm, indicating that arterial narrowing can lead to impaired CBF. Ischemic brain damage was found in one patient who had evidence of cerebral infarction in the territories supplied by the arteries affected by spasm. These findings demonstrate that delayed cerebral arterial spasm is a frequent complication of closed head injury and that the severity of spasm is, in some cases, comparable to that seen in aneurysmal SAH. This experience suggests that vasospasm is an important secondary posttraumatic insult that is potentially treatable.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Blood Flow Velocity
Carotid Artery, Internal physiopathology
Cerebral Arteries physiopathology
Cerebrovascular Circulation
Child
Female
Glasgow Coma Scale
Humans
Ischemic Attack, Transient etiology
Ischemic Attack, Transient physiopathology
Ischemic Attack, Transient therapy
Least-Squares Analysis
Male
Middle Aged
Monitoring, Physiologic
Regression Analysis
Subarachnoid Hemorrhage diagnostic imaging
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography
Xenon Radioisotopes
Craniocerebral Trauma complications
Ischemic Attack, Transient diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 0022-3085
- Volume :
- 77
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 1527618
- Full Text :
- https://doi.org/10.3171/jns.1992.77.4.0575