[Spontaneous subarachnoid hemorrhage,: is emergency transcranial Doppler sonography useful?].

OBJECTIVE

To ascertain the value of transcranial Doppler ultrasonography (TCD) in the first 24 hours of hospital admission in patients suffering good-grade spontaneous subarachnoid hemorrhage (SAH) in order to detect a high-risk group for symptomatic vasospasm.

METHOD

Forty-nine spontaneous good-grade SAH were included. The first TCD studies were carried out at the Emergency Department. At least one more TCD recording was performed between the 4th and 14th day. Patients were classified according to whether they came to the hospital during the first 72 hours after the haemorrhage (Group 1) or later (Group 2).

FINDINGS

Thirty three patients were included in Group 1 and sixteen patients in Group 2. Thirteen patients (26.5%) had sonographic vasospasm. In eight of these patients (61 %), the vasospasm was symptomatic. The initial mean velocity (MV) for Group 1 was normal. The increase in MV/24h (MV/24h) within the first 72 hours after SAH was higher (p< 0.007), in those whose developed sonographic vasospasm. In Group 2, the initial MV was greater (p< 0.001)) in patients who suffered sonographic vasospasm, with or without symptoms.

CONCLUSIONS

The ability of TCD recorded in the first 24 hours of hospital admission to detect high-risk vasospasm patients for SAH with low clinical severity helps decide the most efficient patient destination. During the first three days the MV/24h is of value but not the absolute figure of the MV. In contrast, between the 4th and 14th day after SAH, the absolute figure of MV was useful to predict vasospasm.