Transcranial Dopplerによる脳血管攣縮の診断: 脳血管写, 脳循環時間, 脳血流量との比較検討

抄録

The relationship between the angiographic distribution of vasospasm and the time course changes in MCA flow velocity was examined in 72 patients with aneurysmal subarachnoid hemorrhage. Postoperative carotid angiogram demonstrated no vasospasm in 13 patients, proximal vasospasm (vasospasm restricted to the M1 segment of MCA) in 16, peripheral vasospasm (vasospasm restricted to the M2 or M3 segment of MCA) in 11, and diffuse vasospasm in 32, respectively. Using a mean flow velocity of 120 cm/s as a cut-off value for angiographic vasospasm, the sensitivity of TCD was 80% and the specificity was 100%. The falsenegative cases were those with peripheral vasospasm (four patients) or diffuse vasospasm (two patients) .
Twenty-nine patients developed delayed ischemic neurological deficits (DIND) (seven proximal, six peripheral, and 16 diffuse vasospasm) . Mean flow velocities increased higher than 150 cm/s in 18 patients with DIND, while they remained lower than 100 cm/s in six patients (four peripheral and two diffuse vasospasm) regardless of the development of DIND.
These results suggested that peripheral vasospasm could not be detected by the measurement of blood flow velocity at the basal cerebral arteries alone.