Cerebrovascular hemodynamic changes of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

Objective To investigate the cerebrovascular hemodynamic changes of cerebral vasospasm after aneurysmal subarachnoid hemorrhage(SAH).Methods The clinical records and radiographic images of 337 patients(382 intracranial aneurysms) with aneurysmal subarachnoid hemorrhage were retrospectively reviewed.337 patients in whom aneurysmal SAH was demonstrated by computed tomography,and in whom one or more intracranial aneurysms had been diagnosed by angiography,underwent transcranial Doppler(TCD) studied.297 of them were treated by surgical occlusion using aneurysm clips,29 cases were treated by surgical occlusion using aneurysm clips and parent artery was reshaped,8 cases were treated by surgical isolated aneurysm and 3 cases were treated by surgical parcel.After the operation,patients were treated with Nimodipine,cerebrospinal fluid drainage and 3 H therapy.Blood flow parameters and plateau waves of Willis artery were recorded and analyzed with bedside TCD at 1-3 d,4-7 d,8-14 d,15-20 d after SAH,Especially mean peak flow velocity and Lindegaard index of the middle cerebral artery(MCA).To observe the hemodynamic changes of cerebral vasospasm(CVS) and intracranial pressure(ICP).Results There are cerebral vasospasm with different degrees in aneurysmal subarachnoid hemorrhage.25% of patients appeared CVS in SAH 1-3d,CVS peak in SAH 8-14d.Hunt-Hess grade and positively related to changes in CVS.102 patients(102/337,30.3%) appeared increased intracranial pressure with varying degrees.17 cases(17/337,5%) appeared delayed ischemic neurological dysfunction(DIND).However,there would be higher mortality and neurological deficits when intracranial hypertension and cerebral vasospasm.Conclusions TCD could detect the dynamic hemodynamic changes with aneurismal SAH in an innovative,flexible,accessible tool for the bedside monitoring.The use of TCD velocities,Lindegaard ratio,and plateau waves combination is of useful value for the diagnosis of clinical and angiographic vasospasm.