CEREBRAL VASOSPASM AFTER RUPTURE OF ANTER IOR COMMUNICATING ARTERY ANEURYSMS - SENSITIVITY AND SPECIFICITY OF TRANSCRANIAL DOPPLER SONOGRAPHY

The study was undertaken to determine the sensitivity and specificity of the transcranial Doppler (TCD) for diagnosis of vasospasm after rup ture of anterior communicating artery (CoA) aneurysm. Results provided by 164 carotid angiograms and TCD measures were compared in 40 patien ts with CoA ruptured aneurysm. Twelve patients demonstrated a vasospas m on 22 angiographies. The distribution of angiographic vasospasm was 95.5% anterior cerebral artery (A1), 77.3% pericallosal artery (A2) an d 59.1% middle cerebral artery (M1). A TCD velocity value equal or sup erior to 120 cm/sec was the criterion for TCD vasospasm on M1. The sen sitivity of TCD on M1 for diagnosing vasospasm on M1 with high specifi ty (96.4%) was only 66.7%. A TCD velocity value equal or superior to 8 0 cm/sec, or superior to the homolateral TCD value on M1, was the crit erion for TCD vasospasm on A1. The association of TCD criteria on A1 a nd M1 increased sensitivity to 83.3%, but specificity decreased to 75% . These results demonstrate that TCD is not yet efficient enough to di agnose vasospasm accurately when it is limited to A1. Moreover, the fa ct that vasospasm limited to A1-A2 was symptomatic in three patients s uggests that angiography is still necessary to diagnose VS after CoA r uptured aneurysm.