engleski

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

Subarachnoidal haemorrhage usually occurs following a rupture of saccular aneurysm. The rupture of aneurysm presents an urgent diagnostic problem and following admission of the patients with subarachnoidal haemorrhage- we performed spinal tap, CT scan and, if necessary, cerebral angiography. In this work we analyzed the patients admitted to our hospital in the ten years period, ie. before and after introducing transcranial doppler (TCD) to detect spasm of cerebral arteries. In 1998, 31 patients wore hospitalized because of non-traumatic haemorrhage, and 27 patients were admitted with subarachnoid haemorrhage in 1998. CT scan confirmed the diagnosis of subarachnoidal 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 ruesults, it appears that there were significantly more patients in 1998 with visible aneurysm on angiography, than 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 angiogmphy was a major complaint of radiologists in l988. When we furthert analyzed 6 patients from 1998 in whom angiography showed no one 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 results. 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 haemorrhage ; angiography

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