The value of computed tomography perfusion & transcranial Doppler in early diagnosis of cerebral vasospasm in aneurysmal & traumatic subarachnoid hemorrhage

Abstract

Early detection and diagnosis of cerebral vasospasm in subarachnoid hemorrhage may be challenging both on clinical and radiographic grounds. In this respect we conducted a pilot study in order to assess the feasibility of the technique in the everyday setting of a tertiary hospital and to evaluate the diagnostic performance of different diagnostic computed tomography perfusion aspects in diagnosing the clinical outcome of patients with subarachnoid hemorrhage. Receiver-operating characteristic analysis showed that a cerebral blood flow value of <24.5 presented 67% sensitivity and 100% specificity to diagnose adverse ischemic events at 1 month (p = 0.041). These case series data provide evidence that computed tomography perfusion-derived cerebral blood flow is a measurable index that may detect the degree of cerebral ischemia in a very early stage.

Lay abstract

Early detection and diagnosis of cerebral vasospasm in subarachnoid hemorrhage is important but may be challenging both on clinical or radiographic grounds. This article provides evidence that computed tomography perfusion-derived cerebral blood flow is a measurable index that could detect the degree of cerebral ischemia in a very early stage in patients suffering with subarachnoid hemorrhage. Larger studies are needed in order to better define the role of computed tomography perfusion in early diagnosis of cerebral vasospasm.