VASOSPASM DIAGNOSIS - THEORETICAL SENSITIVITY OF TRANSCRANIAL DOPPLEREVALUATED USING 135 ANGIOGRAMS DEMONSTRATING VASOSPASM - PRACTICAL CONSEQUENCES

The authors inspected 135 angiograms (A degrees) demonstrating vasospa sm (VS) after aneurysm (An) rupture. There were 54 anterior communicat ing artery (ACoA), 38 internal carotid artery (ICA) and 43 middle cere bral artery (MCA) ruptured aneurysms. VS was searched for on each A de grees in distal branches of MCA (M2) proximal MCA (M1), ICA, anterior cerebral artery (A1) and pericallosal artery (A2). In each An group (A CoA - ICA - MCA) the theoretical sensitivity of transcranial doppler ( TCD) was calculated postulating that when present (M1) or (M1 + ICA) o r (M1 + ICA + A1) angiographic VS would be constantly and reliably rec orded by TCD. If only M1 is insonated TCD sensitivity would be 54% aft er ACoA, 82% after ICA and 88% after MCA An rupture. If M1 and ICA are insonated TCD sensitivity would be 61% after ACoA, 95% after ICA and 88% after MCA An rupture. TCD sensitivity would be almost perfect with a reliable and constant A1 insonation but that hypothesis is today pu rely speculative. An additional A degrees appears to be necessary to e stablish VS diagnosis, mainly after ACoA An rupture when a discrepancy is observed between normal TCD data and delayed clinical worsening.