Clinical Neuroscience

[Transcranial doppler detection of cerebral vasospasm following aneurysmal subarachnoid haemorrhage]

BARZÓ Pál1, BORDA Lóránt1, VÖRÖS Erika2, KISS Mariann2, BODOSI Mihály1, DÓCZI Tamás3

JULY 20, 1993

Clinical Neuroscience - 1993;46(07-08)

[In 22 patients with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms serial neurological evaluations, transcranial Doppler examinations and computer tomographic scans were performed. Transcranial Doppler flow velocities were significantly elevated for the group with vasospasm on posthemorrhage day 2. The maximum blood flow velocities were recorded between days 9 and 18, with normalization occurring within the following 3 weeks. Increase in velocity preceded clinical symptoms and could therefore be used as a prognostic factor for the management of patients with subarachnoid hemorrhage. The data also indicated that the extent and location of blood in the subarachnoid space determine the severity and location of vasospasm.]


  1. Szent-Györgyi Albert Orvostudományi Egyetem Idegsebészeti Klinika
  2. Szent-Györgyi Albert Orvostudományi Egyetem Radiológiai Klinika
  3. Pécsi Orvostudományi Egyetem Idegsebészeti Klinika



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[Vascular surgery in the prevention of stroke]

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[Spinal lipomas and their surgery]

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[Elective extra-intracranial arterial bypass in the treatment of giant aneurysms of the carotid artery]


[Clinical details are presented of 5 patients with a giant carotid aneurysm in whom both the occlusion of the aneurysm and the parent internal carotid artery were performed with an extra-intracranial arterial bypass. In the first case ligature of the giant carotid-ophthalmic aneurysm narrowed the parent artery critically and hemiplegia developed. The bypass operation did not improve the clinical outcome. In the second case the occlusion of the aneurysm was performed after an extra-intracranial anastomosis and in spite of the severely narrowed carotid artery the postoperative course was uneventful. In three cases of giant intracavernous aneurysm the occlusion of the carotid artery on the neck and just proximal to the ophthalmic artery was performed in the presence of an arterial bypass. All of the anastomoses were patent and no ischemic event developed during the follow up period. On the basis of these experiences the authors suggest that, if the preoperative tests (TCD, EEG, SPECT) reveal impending ischemic lesion after carotid compression, surgery should be performed with the combination of extra-intracranial bypass.]

Clinical Neuroscience

[Experimental and clinical methods for the measurement of cerebral blood volume]

BERECZKI Dániel, LING Wei, TADAHIRO Otsuka, VIRGIS Acuff, KURT Gruber, CLIFFORD Patlak, JOSEPH Fenstermacher

[A review is given of the methods utilized in evaluating of regional cerebral blood content, both in animal experiments of and the clinical studies with emphasis on the importance and methodological problems of these measurements. A new, double radiolabel method is presented, which is suitable to determine blood content in tissue chunks of 10–30 mg. Red cells are labeled in vivo by 55Fe. The labelled donor” red cells are mixed with 1251-labelled serum albumin and injected intravenously to experimental rats. Red cell and plasma distribution spaces are measured after 3 min circulation time. Regional blood volumes range from 7-30 ul/g, with lowest values in the white matter. Tissue (microvascular) hematocrit is 25-30% lower than large vessel hematocrit.]

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[Quantitative monitoring of EEG variability following subarachnoid hemorrhage]


[Cerebral vasospasm causing focal ischemia is a frequent complication following subarachnoid hemorrhage. Monitoring of EEG may help to reveal hemispheric dysfunction in the postoperative period. Continuous monitoring of EEG was performed on 8 bipolar channel in 30 patients with subarachnoid hemorrhage during the first two weeks after aneurysm rupture. Computerized trend analysis of 8–16 hours long periods was made. Variability of relative alpha power was evaluated visually on a 4 grade scale and it was also measured quantitatively. EEG data were compared with daily transcranial Doppler values and clinical state. Symptomatic vasospasm was detected in 16 patients while other neurological complications developed in a further 4 cases during monitoring. Significant decrease of variability was observed in all of them. This change developed 1-2 days before other signs of vasospasm in 10 patients. The onset of variability decrease was unilateral in 4 cases. No remarkable decrease of variability was found in patients without neurological complication. Our data confirm that EEG monitoring is a useful tool for sensitively detecting deterioration of brain function. Relative alpha variability is an indicative EEG parameter that can signify hemispheric dysfunction caused by ischemia in an early subclinical stage, when still no Doppler signs of vasospasm or deterioration of clinical symptoms occur.]

Clinical Neuroscience

[Alcohol as a risk factor for hemorrhagic stroke (in English language)]


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Clinical Neuroscience

[The effect of cerebrospinal fluid drainage on middle cerebral artery blood flow velocity in conditions with raised intracarnial pressure]


[Middle cerebral artery (MCA) blood flow velocity and intracranial pressure (ICP) were recorded in 42 patients suffering from raised ICP. A major (ICP25 mmHg) or moderate (251CP15 mmHg) degree of intracranial hypertension was reduced by means of either continuous or intermittent CSF drainage. Measurements of MCA blood flow velocity were carried out with transcranial Doppler sonography (TCD). Three types of reactions were observed with regard to cerebral blood flow velocity (CBFV) changes in response to CSF drainage. Patients in Group 1 demonstrated pressure passive CBFV changes throughout the observed cerebral perfusion pressure (PP) range. In Group 2, cerebrospinal fluid (CSF) drainage brought about a transitory increase in CBFV for a few minutes. In Group 3, the reduction of ICP to the normal level did not influence CBFV at all. The pulsatility index (PI) of the cerebrovascular reserve capacity (CVR), which was highest in Group 1, changed in contrast with the CBFV changes in Groups 1 and 2. The pressure-passive velocity pattern (in Group 1) suggests that the blood vessels were at nearly maximum dilatation and were perhaps failing to constrict properly in response to increased PP. As recovery proceeded (Group 2), the mechanism became effective, thereby reestablishing autoregulation. Whereas clinical signs and computed tomography reveal only the trend of the ICP, TCD provides the possibility of a semi-quantitative evaluation of ICP changes and seems especially promising in the rapid assessment of the efficacy of treatment aimed at ICP reduction.]

Clinical Neuroscience

[Measurements of regional cerebral blood flow and blood flow velocity in experimental intracarnial hypertension: infusion via the cisterna magna in rabbits]

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[The cerebral blood flow velocity (CBFV), as measured by transcranial Doppler sonography (TCD) via the transorbital route in the intracranial segment of internal carotid artery (ICA), and the regional cerebral blood (volume) flow (rCBF) in the corresponding cortical areas, as measured by the hydrogen clearance technique, were determined in 8 New Zealand White rabbits undergoing cisterna magna infusion for elevation of the intracranial pressure (ICP). In the lower range of autoregulation, i. e. at perfusion pressures (PP) between 80 and 40 mm of mercury and even below this, the changes in (CBFV) and CBF showed a strong correlation (0,86) under conditions with standard PCO2 (PaCO2)=35+2 mm of mercury). Autoregulation was exhausted at 40 mm of mercury and the cerebrovascular resistance (CVR) was minimal. Below this PP, the CBF and CBV dropped sharply, whereas CVR, gradually increased, indicating that, despite the maximally dilated resistance vessels, the intracranial hypertension causes the vascular resistance to increase, possibly via blocking of the venous outflow. Our results confirmed that non-invasive and easily (even at the bedside) applicable measurements of CBFV changes could substitute the cumbersome and expensive isotope measurements of CBF in intracranial hypertension.]

Clinical Neuroscience

[Blood reflux into the ventricular system in subarachnoid haemorrhage]

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[Medical histories are given of the three patients with subarachnoid hemorrhage (aneurysma rupture was established in two of them) who had also blood in the large quantities in the intraventricular space during the acute phase. Relying upon CT examinations and favourable disease-process the authors suggest it is not the otherwise well known mechanism, when the aneurysm ruptures into the ventricular system resulting in intraventricular and subarachnoid hemorrhage. It is supposed that the blood flowed from the subarachnoid space into the ventricular system by "ventricular reflux" in their cases. The aim task is to analyse the origin of this phenomenon, and to study its possible connection with the development of chronic hydrocephalus after subarachnoid hemorrhage. ]