지주막하출혈에 의한 지연성 허혈신경장애의 진단에 있어서 경두개도플러 검사의 신뢰도

Reliability of Transcranial Doppler Examination in the Diagnosis of Delayed Ischemia after Subarachnoid Hemorrhage

  • 김종문 (원광대학교 의과대학 신경외과학교실) ;
  • 강성돈 (원광대학교 의과대학 신경외과학교실)
  • Kim, Jong Moon (Department of Neurosurgery, School of Medicine, Wonkwang University) ;
  • Kang, Sung Don (Department of Neurosurgery, School of Medicine, Wonkwang University)
  • 투고 : 2000.01.06
  • 심사 : 2000.05.03
  • 발행 : 2000.07.28

초록

Objective : The reliability of transcranial doppler sonography(TCD) for predicting delayed ischemic neurologic deficit( DIND) was investigated in patients with aneurysmal subarachnoid hemorrhage(SAH). Methods : The velocity of blood flow through the middle cerebral artery was measured by TCD in 70 patients treated surgically within 72 hours due to ruptured cerebral aneurysm. A correlation between measured maximal mean blood flow velocities and clinical factors including age, hypertension, Hunt-Hess grade, Fisher grade, DIND, and outcome was made. Results : An age-dependent reduction of the measured maximal mean velocities was found(r=-0.4043, p<0.001). Flow velocities in hypertensive patients were significantly lower than in the normotensive individuals(two-tailed T test, p<0.05). There was no significant difference between the flow velocities and evaluated other clinical factors. When the flow velocities of 14 patients who developed DIND were compared with those of patients without deficits, no significant difference was seen. A significant increase in flow velocities in the days before the onset of DIND was found only in 4 of 14 cases. High flow velocities did not necessarily mean impending neurological deficits : 6 of 70 patients tolerated flow velocities over 160cm/s. Conclusion : We suggest that TCD readings have limited utility for predicting DIND following SAH, especially in older or hypertensive patients. More direct measurements of blood flow are necessary to adequately predict which patients are at high risk of DIND.

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