J Neurointensive Care.  2023 Apr;6(1):49-56. 10.32587/jnic.2023.00633.

Cerebral Vasospasm After Traumatic Subarachnoid Hemorrhage and Its Risk Factor: Combined Periodic Follow Up of Transcranial Doppler and CT Angiography

• Ha J
• Lee S
• Kim S
• Ryou K
• Park T
• Kim J
• Jeong B
• Beak J

• KMID: 2555081
• DOI: http://doi.org/10.32587/jnic.2023.00633

Abstract

Background
Cerebral vasospasm is a prevalent complication in traumatic brain injury (TBI), particularly in cases of traumatic subarachnoid hemorrhage (T-SAH), for which monitoring and treatment policies remain undefined.
Methods
A study was conducted on 49 T-SAH patients with multiple traumas to investigate cerebral vasospasm following T-SAH. Participants underwent transcranial doppler (TCD) and brain CT angiography (CTA) upon hospitalization and subsequent follow-up within seven days. Vasospasm was diagnosed through a comprehensive evaluation of TCD, CTA, and symptoms, with risk factors analyzed accordingly. The initial clinical status was assessed using the Glasgow Coma Scale (GCS), modified Fisher scale (mFS), and Hunt-Hess grade (HHG), while examining various factors to identify underlying risks and evaluating overall body damage via the Injury Severity Score (ISS).
Results
Cerebral vasospasm was confirmed in 19 out of the total 49 patients, which is 38.8%. Furthermore, the characteristics that had a statistically significant correlation with the vasospasm group were low GCS (p=0.03, odd ratio=0.592) and high ISS (p=0.022, odd ratio=1.124). Moreover, patients with vasospasm exhibited worse prognoses based on the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS).
Conclusion
These findings suggest that T-SAH patients with severe initial brain and systemic damage or neurological deficits should undergo active monitoring using modalities such as TCD and CTA, followed by treatment to prevent and manage vasospasm.

Keyword

Traumatic subarachnoid hemorrhage; Vasospasm; Traumatic brain injury; Transcranial doppler