TRANSCRANIAL DOPPLER DETECTION OF ANTERIOR CEREBRAL-ARTERY VASOSPASM

The performance of transcranial Doppler in the detection of anterior c erebral artery vasospasm and vasospasm in patients after subarachnoid haemorrhage was analysed. Transcranial Doppler and cerebral angiograph y were performed within the same 24 hours on each of 41 patients with acute subarachnoid haemorrhage. Sensitivity and specificity of transcr anial Doppler to classify middle cerebral arteries, anterior cerebral arteries, and patients with angiographic vasospasm were determined at mean velocities of 120 and 140 cm/s. Accuracy of transcranial Doppler was better at 140 than at 120 cm/s. For the middle cerebral artery, se nsitivity was 86%, specificity 98%. For the anterior cerebral artery, sensitivity was 13%, specificity 100%. Among all patients, sensitivity was 45%, specificity 96%. Among patients with anterior communicating artery aneurysms, sensitivity was 14%, specificity 90%. Therefore, tra nscranial Doppler accurately differentiates between middle cerebral ar teries with and without vasospasm on angiography, but has a very low s ensitivity for detecting anterior cerebral artery vasospasm and vasosp asm in patients with anterior communicating artery aneurysms. Since va sospasm may involve anterior cerebral arteries while sparing middle ce rebral arteries, especially after rupture of an anterior communicating artery aneurysm, caution should be exercised in using negative transc ranial Doppler results to make treatment decisions based on the assume d absence of vasospasm.