M. De Lima Oliveira, B. Lembo Conde De Paiva, R. Faria Simm, P. Henrique Pires Aguira, E. Bor-Seng-Shu
Department of Neurology, Hospital Santa Paula – São Paulo, Brazil

Objective: Cerebral vasospasm following SAH is one of the main causes of secondary brain injury. The incidence peak is between the 7th and 14th day after bleeding. The management of cerebral vasospasm is based on the triple H therapy, although this therapy may not be enough to control the vasospasm complications. In these cases, mechanical or pharmacological angioplasty on the affected vessel may be indicated if neurological deterioration occurs. Sedated or comatose patients make clinical evaluation difficult and limited. Combining different brain monitoring techniques can provide valuable information that help physicians to identify patients before clinical deterioration.

Material and Methods: A 42 year-old male patient, Caucasian, presented with aneurysmal SAH Fisher IV, Hunt Hess IV, underwent embolisation and surgical clipping later on. At the 3rd day mild vasospasm developed, which became severe at the 5th day. The patient was sedated and underwent multimodal monitoring at the neurological ICU.

Results: The assay of data from cerebral blood flow velocities, Lindegaard index and response to transient hyperemia test (RTHT) obtained by transcranial Doppler along with data from ICP, CPP and PbtO2 enabled to determine a better time window to perform angioplasty in this case. At that time signs of vasospasm worsening was detected by TCD associated with reduced response to RTHT, increases in ICP and decreases in PbtO2; we decided to indicate angioplasty with good results in terms of the monitored brain physiological variables.

Discussion: Multimodal brain monitoring, including transcranial Doppler monitoring can provide real-time brain physiological data which allow to detect brain physiological deterioration in unconscious patients; this enables more precise indication of angioplasty for cerebral vasospasm

Key words: angioplasty brain vasospasm, oximetry catheter, transcranial Doppler, transient hyperemia test.

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