CEREBRAL VASOSPASM FOLLOWING POSTTRAUMATIC SUBARACHNOID HEMORRHAGE EVALUATED BY TRANSCRANIAL DOPPLER ULTRASONOGRAPHY

We studied the incidence and time course of flow velocity changes sugg esting a vasospasm following post-traumatic subarachnoid hemorrhage (S AH) considering the intracranial pressure (ICP) in 38 SAH patients as compared to 30 patients with spontaneous SAH. The first investigation was done within 24 h after onset of hemorrhage and regularly followed up during the clinical course. Additionally, the index of cerebral cir culatory resistance was calculated and the ICP was measured using an e pidural transducer. A significant correlation between middle cerebral artery maximum mean flow velocity and the quantity of blood seen on a computed tomographic scan in patients with post-traumatic SAH indicate s a similar pathogenetic mechanism of the development of vasospasm to that after spontaneous SAH. In contrast, there was a significantly ear lier occurrence of mean flow velocities over 120 cm/s following post-t raumatic SAH irrespective of the ICP. Therefore, additional factors mu st be considered in the evaluation of these pathologically raised flow velocities after posttraumatic SAH. In both SAH groups there was a hi ghly significant correlation between clinical outcome and clinical gra de on admission, ICP and resistance index. The weak correlation betwee n maximum mean flow velocity and clinical outcome following post-traum atic SAH supports the notion that final clinical outcome of these pati ents is of multifactorial origin.