Predicting value of vasospasm on Transcranial Doppler in detection of delayed brain infarction in patients with subarachnoid hemorrhage

Cerebral vasospasm is one of the most dreaded complications during the clinical course of aneurysmal Sub-Arachnoid Hemorrhage (SAH). Evaluation of the relationship between presence of vasospasm in Transcranial Doppler (TCD) and Delayed Brain Infarction (DBI) was the aim of this study. Methods and Materials: Consecutive patients with Subarachnoid Hemorrhage (SAH) admitted in Ghaem hospital, Mashhad during 2005-2010 enrolled in a prospective clinical study. Diagnosis and work up of SAH was performed by neurologists. All of the SAH patients underwent serial TCD during 4-14 days post events by certified neurosonologists blinded to the angiographic results. Presence of DBI was confirmed on neuroimaging by neurologists. Vasospasm in TCD was found in 56 patients (30.9%). Brain infarction in brain CT was observed in 17 SAH patients;12 females and 5 males (9.4%) with mean age 51.6 ±7.1 years. The mean time from SAH onset to development of vasospasm on TCD and mean time from occurance of vasospasm on TCD to development of brain infarction on brain CT was 8.51±2 and 9.06±4 days respectively. Difference in distribution of BDI based on the presence and severity of vasospasm on TCD was significant; p<0.001. Moderate and sever vasospasm on TCD had low sensitivity and high specificity for prediction of DBI. While, mild vasospasm on TCD had high sensitivity and moderate specificity for prediction of DBI. Although DBI in SAH patients is usually found in patients with vasospasm on TCD. However, Presence of any degree of vasospasm on TCD had low PPV for prediction of DBI in our SAH patients.