engleski

Important role of transcranial doppler in subarachnoidal haemorrhage in reducing a number of false-negative angiography results

Subarachnoidal haemorrhage ussually occurs following a rupture of saccular aneurysm. The rupture of aneurysm presents an urgent diagnostic problem and following admission of patients with subaracnoidal haemorrhage we performed lumbar puncture, CT scan and, if necessary, cerebral angiography. In this work we analysed the patients admitted to our hospital in the ten year period, i.e. before and after introducing transcranial doppler (TCD) to detect spasm of cerebral arteries. In 1998, 31 patients were hospitalized because of non-traumatic subaracnoidal haemorrhage, and 27 patients were admitted with subarachnoidal haemorrhage in 1988. CT scan confirmed the diagnosis of subaracnoidal haemorrhage in 83% of patients admitted in 1998 and in 92% of patients in 1988, respectively. Further on, cerebral angiography showed an aneurysm in 81 % with positive CT scan in 1998, and in 55% of patients in 1988, respectively. From these results, it appears that there were significantly more patients in 1998 with visible aneurysm on angiography, then ten years earlier. This was to great extent due to the use of TCD for daily monitoring of cerebral vasospasm and, therefore, better timing for angiography. Vasospasm on angiography was a major complaint of radiologists in 1988. When we further analysed 6 patients from 1988 in whom angiography showed no aneurysm, 4 of them had cerebral vasospasm on transcranial doppler, and this may be the reason they had false-negative angiography. In conclusion TCD is a valuable non-invasive tool for diagnostics of cerebral circulation and should be used for daily monitoring of cerebral vasospasm to decrease a number of false-negative angiography resultss. In addition to TCD, we found a marked effect of continuous intravenous application of nimodipine in prevention and reducing cerebral vasospasm, so decreasing possibility of early ishaemic stroke while waiting for surgery.

transcranial Doppler ; subarachnoidal heamorrhage

nije evidentirano