PDF(Pubmed)
Abstract：
BACKGROUND: Effective management of patients with aneurysmal subarachnoid hemorrhage (aSAH) demands vigilant monitoring and treatment, given the risks of complications such as cerebral vasospasm and delayed ischemic neurological deficits (DINDs). Transcranial transmission ultrasound (TTUS) is a well-established technique for assessing brain pulsatility. This pilot study aims to explore the utility of TTUS in detecting impaired intracerebral blood flow associated with DINDs.
METHODS: The authors examined 2 male patients, ages 45 and 52 years, with aSAH Hunt and Hess grades 4 and 2, respectively, who developed DINDs during their clinical course. Simultaneous recordings of arterial blood pressure, heart rate, and TTUS measurements were obtained in the intensive care unit. TTUS analysis revealed abnormal arrhythmic wave patterns during DIND episodes, whereas baseline measurements on DIND-free days showed no abnormalities. Following endovascular spasmolysis, TTUS demonstrated a normalization of abnormal waves, returning to baseline levels, alongside the resolution of neurological symptoms.
CONCLUSIONS: TTUS, a noninvasive method for assessing brain pulsatility, shows promise as a novel tool for monitoring aSAH patients, potentially aiding in prompt diagnostics and additional therapeutic interventions. Its capacity to provide further insights for individuals at risk of delayed cerebral ischemia warrants further investigation in clinical studies. https://thejns.org/doi/10.3171/CASE24146.
METHODS: The authors examined 2 male patients, ages 45 and 52 years, with aSAH Hunt and Hess grades 4 and 2, respectively, who developed DINDs during their clinical course. Simultaneous recordings of arterial blood pressure, heart rate, and TTUS measurements were obtained in the intensive care unit. TTUS analysis revealed abnormal arrhythmic wave patterns during DIND episodes, whereas baseline measurements on DIND-free days showed no abnormalities. Following endovascular spasmolysis, TTUS demonstrated a normalization of abnormal waves, returning to baseline levels, alongside the resolution of neurological symptoms.
CONCLUSIONS: TTUS, a noninvasive method for assessing brain pulsatility, shows promise as a novel tool for monitoring aSAH patients, potentially aiding in prompt diagnostics and additional therapeutic interventions. Its capacity to provide further insights for individuals at risk of delayed cerebral ischemia warrants further investigation in clinical studies. https://thejns.org/doi/10.3171/CASE24146.
摘要：
背景：动脉瘤性蛛网膜下腔出血（aSAH）患者的有效治疗需要警惕的监测和治疗，考虑到脑血管痉挛和迟发性缺血性神经功能缺损（DINDs）等并发症的风险。经颅透射超声（TTUS）是一种公认的评估脑搏动性的技术。这项初步研究旨在探索TTUS在检测与DIND相关的脑内血流受损中的实用性。
方法：作者检查了2名男性患者，年龄45岁和52岁，ASAHHunt和Hess分别为4级和2级，他们在临床过程中出现了DINDs。同时记录动脉血压,心率,和TTUS测量是在重症监护病房获得的。TTUS分析显示DIND发作期间异常的心律失常波型，而无DIND日的基线测量结果未显示异常.血管内痉挛后,TTUS表现出异常波的正常化，回到基线水平，除了神经系统症状的解决。
结论：TTUS，一种评估大脑搏动的非侵入性方法，显示出有望作为监测aSAH患者的新工具，可能有助于及时诊断和额外的治疗干预。它为有延迟脑缺血风险的个体提供进一步见解的能力值得在临床研究中进一步研究。https://thejns.org/doi/10.3171/CASE24146。
方法：作者检查了2名男性患者，年龄45岁和52岁，ASAHHunt和Hess分别为4级和2级，他们在临床过程中出现了DINDs。同时记录动脉血压,心率,和TTUS测量是在重症监护病房获得的。TTUS分析显示DIND发作期间异常的心律失常波型，而无DIND日的基线测量结果未显示异常.血管内痉挛后,TTUS表现出异常波的正常化，回到基线水平，除了神经系统症状的解决。
结论：TTUS，一种评估大脑搏动的非侵入性方法，显示出有望作为监测aSAH患者的新工具，可能有助于及时诊断和额外的治疗干预。它为有延迟脑缺血风险的个体提供进一步见解的能力值得在临床研究中进一步研究。https://thejns.org/doi/10.3171/CASE24146。
