Transcranial dopplerosonography in subarachnoid hemorrhagen / Монголын Анагаах Ухаан

ABSTRACT

Background@#The incidence of acute SAH has been estimated at 2–22 cases per 100 000 persons per year. The most common cause of basal acute SAH is a ruptured cerebral aneurysm. Cerebral vasospasm in the first 2 weeks after aneurysmal subarachnoid hemorrhage is recognized as a major predictor of delayed cerebral ischemia. From 2014 through 2018, 5272 patients with a stroke (amongst them 20.4% were patients with aSAH) were hospitalized in the 3rd State Central Hospital of Mongolia.@*Objective@#To study the clinical features of the cerebral vasospasm and dopplerosonography parameters in the aSAH patients. @*Materials and Methods@#The methods, methodology and ethics of the research work were discussed at a Research meeting of Ethics Control Committee of the Mongolian National University of Medical Sciences held on December 22, 2017 (No2017 / 3-05), and the study was performed in accord with approval.</br> 60 patients with aSAH (hospitalized from 2017 to 2018 year) were enrolled in the case-control study. Informed consent were obtained from each participants. Clinical condition of participants was classified by Hunt-Hess scale (HHS). Cerebral vasospasm degree was graded by Lindegaard index.@*Results@#52.5% of the participants were men and 47.5% were women. Average age was 49.9±12. When clinical condition degree was compared to vasospasm grade it was revealed that amongst 1st degree of Hunt-Hess scale (HHS) group 11.1% of enrolled patients’ spasm was normal or had no spasm, while it was observed either 44.4% mild and moderate spasm. In the 2nd degree of HHS group: normal in 6.9%, mild in 3.4%, moderate in 86.2%, and severe spasm was in 3.4%. In the 3rd degree of HHS group, 11.1% had no spasm, moderate spasm was in 77.8%, and severe spasm was in 11.1%. In 4th degree of HHS group, 71.4% were with moderate spasm, 28.6% were with severe spasm (p = 0.001). </br> When the Hunt-Hess Scale was compared to the Sinus Rectus 1st degree of Hunt-Hess scale (HHS) group Sinus Rectus was normal for 22.2% patients, mild for 66.7% and severe for 11.1%. Though 4th and 5th degree of Hunt-Hess scale (HHS) groups’ Sinus Rectus mild for 7.1% normal, 50.0% mild and 42.9% severe (p=0.007). Thus whenever the clinical condition worsened the cerebral intracranial pressure was increasing.@*Conclusion@#aSAH patients clinical complication degree were directly associated with the cerebral vasospasm revealed by the transcranial dopplerosonography. Therefore, the evaluation of Hunt-Hess scale has an important significance in the prevention from clinical complications and in the selection of the appropriate treatment approaches for aSAH patients.