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Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Using Cerebral Blood Flow Velocities and Cerebral Autoregulation Assessment

Neurocritical Care volume 23, pages 253–258 (2015)Cite this article

Abstract

Background

The risk of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is associated with large cerebral artery vasospasm, but vasospasm is not a strong predictor for DCI. Assessment of cerebral autoregulation with transcranial Doppler (TCD) may improve the prediction of DCI. The aim of this prospective study was to assess the value of TCD-derived variables to be used alone or in combination for prediction of DCI.

Methods

We included consecutive patients with low-grade aneurysmal SAH within 4 days of aneurysm rupture. Cerebral autoregulation was evaluated using the moving correlation coefficient Mx calculated from spontaneous fluctuations of cerebral blood flow velocities and arterial blood pressure. Transcranial color-coded sonography was performed to assess large artery vasospasm.

Results

Thirty patients (19 women and 11 men; mean age ± SD 44.7 ± 12.1 years) were included. Twenty (66.7 %) patients had vasospasm. DCI occurred in six (20 %) patients after a median delay of 10 days (range 8–13 days). Cerebral autoregulation was impaired at baseline and at day 7 and then returned to normal at day 14. Neither cerebral autoregulation impairment nor large artery vasospasm alone was associated with DCI. In contrast, the combination of large artery vasospasm with worsening impairment of cerebral autoregulation from baseline to day 7 was significantly correlated to subsequent DCI (p = 0.007).

Conclusions

Early deterioration of cerebral autoregulation was strongly predictive of DCI in patients with large artery vasospasm after low-grade SAH. Our results suggest that consideration to both cerebral blood flow velocities and cerebral autoregulation may improve the prediction of DCI.

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Acknowledgments

This work was supported by a grant from “la Direction de la Recherche Clinique et de l’Innovation (DRCI)” at Toulouse University Hospital, Toulouse, France. Portions of this work were presented in oral communication form at the National Neurosurgery Conference, Toulouse, France, 2012 and at the International Stroke Conference, Hawaï, Honolulu, 2013.

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author information

Affiliations

  1. Department of Neurology, University Hospital of Toulouse, Toulouse, France

    Lionel Calviere, Nathalie Nasr, Alain Viguier & Vincent Larrue

  2. Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France

    Bernard Tissot & Jean-Christophe Sol

  3. Department of Biostatistics and Epidemiology, University Hospital of Toulouse, Toulouse, France

    Catherine Arnaud

  4. Academic Neurosurgical Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Marek Czosnyka

  5. Neurovascular Unit, Department of Neurology, CHU Purpan, Hopital Pierre Paul Riquet, Place du Dr Baylac, 31059, Toulouse Cedex 9, France

    Lionel Calviere

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  1. Lionel Calviere
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  2. Nathalie Nasr
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  3. Catherine Arnaud
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Correspondence to Lionel Calviere.

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Calviere, L., Nasr, N., Arnaud, C. et al. Prediction of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage Using Cerebral Blood Flow Velocities and Cerebral Autoregulation Assessment. Neurocrit Care 23, 253–258 (2015). https://doi.org/10.1007/s12028-015-0125-x

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Keywords

  • Cerebral autoregulation
  • Transcranial Doppler
  • Subarachnoid hemorrhage
  • Vasospasm