Abstract
To see whether it is possible to predict the outcome of a cerebral ischemic attack in patients with a previous subarachnoid hemorrhage (SAH), the intracranial hemodynamics have been evaluated In 43 SAH patients. Using transcranial Doppler blood flow mapping (TCDM), the flow velocity (FV) and Fourier's transformed pulsatility index (FPI) of 10 harmonics (FPI_<1-10>) of each patient were analyzed, and based on the type of vasospasm, the patients were divided into five groups, i. e., groups I, II, IIIa, IIIb, and IV. In all five groups, a significant correlation was found between the appearance of delayed neurological deficits (DINDs), the I ^<123>-IMP-SPECT, and conventional CT findings, and the Glasgow Outcome Scale (GOS). Group I had the best outcome, whereas group IV had the poorest prospects. Possible hyperemia and/or an increased blood volume was suspected in patients in group II who showed an FV greater than 120 cm/s and a decreased FPI_1 (≤ 0.15) , but no DINDS Were noted nor were ischemic lesions seen on CT, and the final outcome was good. In groups IIIa and IIIb, many cases showed an Increased FV (≥ 120 cm/s) and an FPI_1 that was either normal (0.15 <FPI_1 ≤0.30 : IIIa) or increased FPI_1(0.30 <FPI_1 ≤0.50 : IIIb) , as well as increased FPI_<5-6> values, DINDs, and ischemic lesions on SPECT and CT visualization. Our results have indicated that the prognosis for SAH patients with a vasospasm is poor, if there is an increase in both the FV and FPI_<1,5,6> Values, since DINDS and irreversible cerebral ischemia are likely to occur.
