Acta Neurochirurgica

, Volume 161, Issue 2, pp 385–392 | Cite as

How is vasospasm screening using transcranial Doppler associated with delayed cerebral ischemia and outcomes in aneurysmal subarachnoid hemorrhage?

  • M. HollingworthEmail author
  • A. A. B. Jamjoom
  • D. Bulters
  • H. C. Patel
Original Article - Vascular Neurosurgery - Other
Part of the following topical collections:
  1. Vascular Neurosurgery – Other



Delayed cerebral ischemia (DCI) is an independent predictor of an unfavorable outcome after aneurysmal subarachnoid hemorrhage (aSAH). Many centers, but not all, use transcranial Doppler (TCD) to screen for vasospasm to help predict DCI. We used the United Kingdom and Ireland Subarachnoid Haemorrhage (UKISAH) Registry to see if outcomes were better in centers that used TCD to identify vasospasm compared to those that did not.


TCD screening practices were ascertained by national survey in 13 participating centers of the UKISAH. The routine use of TCD was reported by 5 “screening” centers, leaving 7 “non-screening” centers. Using a cross-sectional cohort study design, prospectively collected data from the UKISAH Registry was used to compare DCI diagnosis and favorable outcome (Glasgow Outcome Score 4 or 5) at discharge based on reported screening practice.


A cohort of 2028 aSAH patients treated ≤ 3 days of hemorrhage was analyzed. DCI was diagnosed in 239/1065 (22.4%) and 220/963 (22.8%) of patients in non-screening and screening centers respectively while 847/1065 (79.5%) and 648/963 (67.2%) achieved a favorable outcome. Odds ratios adjusted for age, injury severity, comorbidities, need for cerebrospinal fluid diversion, and re-bleed returned neutral odds of diagnosing DCI of 0.90 (95% CI 0.72–1.12; p value = 0.347) in screening units compared to those of non-screening units but significantly decreased odds of achieving a favorable outcome 0.56 (95% CI 0.42–0.82; p value < 0.001).


Centers that screened for vasospasm using TCD had poorer in-hospital outcomes and similar rates of DCI diagnosis compared to centers that did not.


Delayed cerebral ischemia Vasospasm Subarachnoid hemorrhage Aneurysm Neuromonitoring Transcranial Doppler Screening 



We thank Professor Mark Hamer for his statistical advice and Dr Alice Harper for her editorial assistance.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, no formal consent was required.


  1. 1.
    Connolly E, Rabinstein A, Carhuapoma J et al (2012) Guidelines for the management of aneurysmal subarachnoid haemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43(6):1711–1737CrossRefGoogle Scholar
  2. 2.
    Dorsch N (2011) A clinical review of cerebral vasospasm and delayed ischaemia following aneurysm rupture. Acta Neurochir Suppl 110:5–6Google Scholar
  3. 3.
    Erlich G, Kirshning T, Wenz T et al (2016) Is there an influence of routine daily transcranial Doppler examination on clinical outcome in patients after aneurysmal subarachnoid hemorrhage? World Neurosurg 88:214–221CrossRefGoogle Scholar
  4. 4.
    Francoeur C, Mayer S (2016) Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 20:277CrossRefGoogle Scholar
  5. 5.
    Gathier C, van den Bergh W, van der Jagt M et al (2018) Induced hypertension for delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage: a randomised clinical trial. Stroke 49(1):76–83CrossRefGoogle Scholar
  6. 6.
    Hollingworth M, Chen P, Goddard A et al (2015) Results of an international survey on the investigation and endovascular management of cerebral vasospasm and delayed cerebral ischemia. World Neurosurg 83:1120–1126CrossRefGoogle Scholar
  7. 7.
    Kissoon N, Mandrekar J, Fugate J et al (2015) Positive fluid balance is associated with poor outcomes in subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 24:2245–2251CrossRefGoogle Scholar
  8. 8.
    Kumar G, Albright K, Donnelly J et al (2017) Trends in transcranial Doppler monitoring in aneurysmal subarachnoid hemorrhage: a 10-year analysis of the nationwide inpatient sample. J Stroke Cerebrovasc Dis 26:851–885CrossRefGoogle Scholar
  9. 9.
    Kumar G, Shahripour R, Harrigan M (2016) Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg 124(5):1257–1264CrossRefGoogle Scholar
  10. 10.
    Linn F, Rinkel G, Algra A, Van Gijn J. (1996) Incidence of subarachnoid hemorrhage role of region, year, and rate of computed tomography: a meta-analysis. Stroke; 27:625–629Google Scholar
  11. 11.
    Lennihan L, Mayer S, Fink M et al (2000) Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage a randomized controlled trial. Stroke 31:383–391CrossRefGoogle Scholar
  12. 12.
    Lovelock C, Rinkel G, Rothwell P (2010) Time trends in outcome of subarachnoid hemorrhage population-based study and systematic review. Neurology 74:1494–5101CrossRefGoogle Scholar
  13. 13.
    Macdonald R, Schweizer T (2017) Spontaneous subarachnoid haemorrhage. Lancet 389:655–666CrossRefGoogle Scholar
  14. 14.
    Mackey J, Khoury J, Alwell K et al (2016) Stable but declining case-fatality rates of subarachnoid haemorrhage in a population. Neurology 22(87):2192–2197CrossRefGoogle Scholar
  15. 15.
    Muench E, Horn P, Bauhuf C et al (2007) Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Crit Care Med 35(8):1844–1851CrossRefGoogle Scholar
  16. 16.
    Raabe A, Beck J, Keller M et al (2005) Relative importance of hypertension compared with hypervolemia for increasing cerebral oxygenation in patients with cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 103(6):974–981CrossRefGoogle Scholar
  17. 17.
    Raper D, Allan R (2010) International subarachnoid trial in the long run: critical evaluation of the long-term follow-up data from the ISAT trial of clipping vs coiling for ruptured intracranial aneurysms. Neurosurgery 66:1166–1169CrossRefGoogle Scholar
  18. 18.
    Rinkel G, Algra A (2011) Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 10:349–356CrossRefGoogle Scholar
  19. 19.
    Rooji N, Rinkel G, Dankbaar J et al (2013) Delayed cerebral ischaemia after subarachnoid haemorrhage: a systematic review of clinical laboratory and radiological predictors. Stroke 44(1):43–54CrossRefGoogle Scholar
  20. 20.
    Roos R, de Haan R, Beenen L et al (2000) Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based study in the Netherlands. J Neurol Neurosurg Psychiatry 68:337–341CrossRefGoogle Scholar
  21. 21.
    Rosengart A, Axhultheiss K, Tolentino J et al (2007) Prognostic factors for outcome in patients with aneurysmal subarachnoid haemorrhage. Stroke 38(8):2315–2321CrossRefGoogle Scholar
  22. 22.
    Scott R, Eccles F, Molyneux A et al (2010) Improved cognitive outcomes with endovascular coiling of ruptured intracranial aneurysms neuropsychological outcomes from the International Subarachnoid Aneurysm Trial (ISAT). Stroke 41:1743–1747CrossRefGoogle Scholar
  23. 23.
    Stegmayr B, Eriksson M, Asplund K (2004) Declining mortality from subarachnoid hemorrhage changes in incidence and case fatality from 1985 through 2000. Stroke 35:2059–2063CrossRefGoogle Scholar
  24. 24.
    Teasdale G, Drake C, Hunt W et al (1988) A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 51:1457CrossRefGoogle Scholar
  25. 25.
    Vergouen M, Vermeulen v GJ et al (2010) Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies. Stroke 41(10):2391–2395CrossRefGoogle Scholar
  26. 26.
    Wilson D, Nakaji P, Albuquerge F et al (2013) Time course of recovery following poor grade SAH: incidence of delayed improvement and implications for SAH outcome study design. J Neurosurg 119:606–612CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Queen’s Medical CentreNottingham University Hospitals TrustNottinghamUK
  2. 2.Department of Clinical Neurosciences, Western General HospitalEdinburghUK
  3. 3.Department of NeurosurgerySouthampton General HospitalSouthamptonUK
  4. 4.Department of NeurosurgerySalford Royal InfirmaryGreater ManchesterUK

Personalised recommendations