Summary
A retrospective analysis was undertaken to determine whether cerebral vasospasm following subarachnoid haemorrhage (SAH) correlates with the age of patients. For at least 3 weeks after bleeding 80 subjects underwent very close follow-up with clinical examination and transcranial Doppler records of the blood velocities within the basal cerebral arteries.
Firstly a correlation between measured maximal mean blood flow velocities and age was made. Secondly, according to their age and the maximum of recorded mean velocitites (v), the patients were divided into groups as follows: age 55 years or less, age more than 55 years; and maximum velocity v1<90cm/s, 90cm/s<v2<120cm/s, 120cm/s<v3<160cm/s, v4>160cm/s.
There was a significant correlation of the measured maximum mean velocities and the age of the patients (r =−0.525, p<0.01). With regard to the velocity groups there was a significant (chisquared statistic for contingency tables, p<0.01) difference between both age-groups: 32% (n=18) of the younger fell into group v4 with maximum mean velocities of more than 160cm/s, but none of the older had such. Vice versa, 63% (n=15) of the older compared with only 14% (n=8) of the younger fell into group v1 with maximum mean velocities of less than 90 cm/s. Clinical follow-up also depicted differences between both age groups. 13 of 18 younger patients with maximum mean velocities >160 cm/s exhibited symptomatic vasospasm with a delayed neurological deficit. This typical course did not occur in the older age group.
We conclude from this analysis that the increase of blood velocity in the basal cerebral arteries following subarachnoid haemorrhage depends on the age of the patient. Furthermore, young patients will be more prone to a delayed ischaemic deficit. On the other hand, older patients may also suffer ischaemic deficits following subarachnoid haemorrhage but often without measurable vasospasm according to transcranial Doppler criteria and without the typical delayed appearance.
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References
Aaslid R, Huber P, Nornes H (1982) Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60: 37–41
Arnolds BJ, Reutern GM (1986) Transcranial Doppler sonography. Examination technique and normal reference values. Ultrasound Med Biol 12: 115–123
Artiola i Fortuny L, Prieto-Valiente L (1981) Long-term prognosis in surgically treated intracranial aneurysms. Part 1: mortality. J Neurosurg 54: 26–34
Davis SM, Ackermann RH, Correia JA, Alpert NM, Chang J, Buonanno F, Kelley RE, Rosner B, Taveras JM (1983) Cerebral blood flow and cerebrovascular CO2 reactivity in stroke-age normal controls. Neurology 33: 391–399
Ecker A, Riemenschneider PA (1951) Arteriographic demonstration of spasm of the intracranial arteries: with special reference to saccular arterial aneurysms. J Neurosurg 8: 660–667
Frackowiak RSJ, Wise RJS, Gibbs JM, Jones T (1984) Positron emission tomographic studies in aging and cerebrovascular disease at Hammersmith Hospital. Ann Neurol 15 [Suppl]: 112–118
Grolimund P, Seiler RW (1988) Age dependence of the flow velocity in the basal cerebral arteries — a transcranial Doppler ultrasound study. Ultrasound Med Biol 14/3: 191–198
Harders AG, Gilsbach JM (1987) Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound. J Neurosurg 66: 718–728
Harders AG, Gilsbach JM, Hornyak ME (1988) Transcranial Doppler evaluation of cerebral vasospasm. In: Wilkins RH (ed) Cerebral vasospasm. Raven, New York, pp 33–52
Hassler W, Chioffi F (1989) CO2 reactivity of cerebral vasospasm after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 98: 167–175
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysm. J Neurosurg 28: 14–20
Hunt WE, Kassell N, Pertuiset B, Sano K, Teasdale G, de Villier J, Drake CG (1988) Report of the World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Haemorrhage Grading Scale. J Neurosurg 68: 985–986
Ljunggren B, Brandt L, Säveland H, Nilsson P-E, Cronqvist S, Andersson K-E, Vinge E (1984) Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg 61: 864–873
Melamed E, Lavy S, Bentin S, Cooper G, Rinot Y (1980) Reduction in regional cerebral blood flow during normal aging in man. Stroke 11/1: 31–34
Oka K, Kuromatsu C, Takaki T, Maeyama R, Fukui M, Kitamura K (1987) Therapeutic problems in aged patients with intracranial aneurysms. No Shinkei Geka 15/4: 375–379
Seiler RW, Grolimund P, Aaslid R, Huber P, Nornes H (1986) Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid haemorrhage. J Neurosurg 64: 594–600
Seiler RW, Grolimund P (1988) Transcranial Doppler evaluation of cerebral vasospasm. In: Wilkins RH (ed) Cerebral vasospasm. Raven, New York, pp 19–23
Sloan MA, Haley EC Jr, Kassell NF, Henry ML, Stewart SR, Beskin RR, Sevilla EA, Torner JC (1989) Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid haemorrhage. Neurology 39: 1514–1518
Vriens EM, Kraaier V, Musbach M, Wieneke GH, van Huffelen AC (1989) Transcranial pulsed Doppler measurements of blood velocity in the middle cerebral artery: reference values at rest and during hyperventilation in healthy volunteers in relation to age and sex. Ultrasound Med Biol 15/1: 1–8
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Boecher-Schwarz, H.G., Ungersboeck, K., Ulrich, P. et al. Transcranial Doppler diagnosis of cerebral vasospasm following subarachnoid haemorrhage: Correlation and analysis of results in relation to the age of patients. Acta neurochir 127, 32–36 (1994). https://doi.org/10.1007/BF01808543
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DOI: https://doi.org/10.1007/BF01808543