Blood flow velocities in middle cerebral artery branches after subarachnoid hemorrhage

In a prospective study, 55 patients were examined by transcranial duplex so nography (TCCS) after subarachnoid hemorrhage (SAH) to determine whether ad ditional transcranial duplex examination on the middle cerebral artery M2 s egments would aid in the examination of the-MCA stem segment. The mean;bloo d flow velocities and pulsatility index were correlated to the occurrence o f delayed ischemic neurologic deficits (DIND). Out: of 47 patients included , 21 did not experience any delayed deficit (group 1), 15 did (group II), a nd in 11 the extent to which vasospasm contributed to a neurologic deficit was unclear (group III). The highest blood flow velocity and the greatest i ncrease of mean blood flow velocity on 1 day were significantly higher in g roups II and III both in M1 and in M2. In 10 patients in group II, where th e onset day of DIND was known exactly, Doppler data indicating ischemia bef ore or at the time of DIND were observed in nine. In eight patients, Dopple r of the MCA stem alone would have provided enough information to recognize the risk of symptomatic vasospasm; in one patient, only the M2 Doppler gav e an indication of ischemic complication. Transcranial duplex sonography ma y provide additional information to TCD by accurate delineation of M1/M2 va sospasm and therefore may help plan cerebral angiography and neurointervent ional treatment.