Document Detail

Basilar vasospasm following spontaneous and traumatic subarachnoid haemorrhage: clinical implications.
MedLine Citation:
PMID:  11862513     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cerebral vasospasm has been commonly described following subarachnoid haemorrhage (SAH) though its impact on neurological outcome, especially in head trauma, has not been yet elucidated. The purpose of this study was to monitor and correlate neurological condition and flow velocities (FVs) in the arteries of the brain after SAH and more particularly to investigate the influence of basilar artery (BA) vasospasm on neurological outcome. METHODS: Daily transcranial Doppler (TCD) evaluations were conducted in 116 consecutive patients with subarachnoid haemorrhage. SAH was of traumatic origin (tSAH) in 59 patients and spontaneous (sSAH) in 57 patients. Vasospasm in the MCA and ACA was defined by a mean FV exceeding 120 cm/s and three times the mean FV of the ipsilateral ICA. Basilar artery (BA) vasospasm was defined as moderate whenever the FV was higher than 60 cm/s and severe above 85 cm/s. FINDINGS: Sixty-two patients (53.4%) had elevated FVs in the BA, among these 34 (29.3%) had FVs above 85 cm/s. Basilar vasospasm was significantly more common in tSAH (59.7%) than in sSAH (40.3%, P=0.041). In patients with moderate and severe BA vasospasm, FVs in the BA increased on the third day after admission and remained elevated for a week before returning to normal value by the end of the second week. This elevation in BA FVs in patients with BA vasospasm was followed by a significant and progressive worsening in the neurological condition at the end of the first week. Permanent neurological deficit was associated with elevated BA FVs consistent with moderate BA vasospasm whereas patients who remained in persistent vegetative state, had FVs consistent with severe BA vasospasm (P=0.00019). INTERPRETATION: The present results further support that BA vasospasm may act as an independent factor of ischaemic brain damage following SAH, especially in head trauma.
J F Soustiel; V Shik; M Feinsod
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta neurochirurgica     Volume:  144     ISSN:  0001-6268     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2002 Feb 
Date Detail:
Created Date:  2002-03-07     Completed Date:  2002-05-07     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  137-44; discussion 144     Citation Subset:  IM    
The Brain Injury Applied Research Center, Department of Neurosurgery, Rambam Medical Center, The Technion Israel Institute of Technology, Haifa 31096, Israel.
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MeSH Terms
Aged, 80 and over
Basilar Artery / pathology*
Brain Ischemia / etiology,  pathology
Craniocerebral Trauma / complications*
Middle Aged
Severity of Illness Index
Subarachnoid Hemorrhage / complications*
Vasospasm, Intracranial / etiology*,  pathology

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