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(Stroke. 1998;29:422-428.)
© 1998 American Heart Association, Inc.

Original Contributions

Effects of Induced Hypertension on Transcranial Doppler Ultrasound Velocities in Patients After Subarachnoid Hemorrhage

E. M. Manno, MD; D. R. Gress, MD; L. H. Schwamm, MD; M. N. Diringer, MD; C. S. Ogilvy, MD

From the Neurology/Neurosurgery Intensive Care Unit, Washington University School of Medicine, St Louis, Mo (E.M.M., M.N.D.); Neurovascular Stroke Service, University of California at San Francisco (D.R.G.); and Acute Stroke Service and Department of Neurosurgery, Harvard Medical School and Massachusetts General Hospital, Boston, Mass (L.H.S., C.S.O.).

Correspondence to Edward M. Manno, MD, Washington University School of Medicine, Department of Neurology, Campus Box 8111, 660 S Euclid Ave, St Louis, MO 63110. E-mail mannoe{at}neuro.wustl.edu

Background and Purpose—Transcranial doppler ultrasound (TCD) is used after subarachnoid hemorrhage to detect cerebral vasospasm and is often treated with induced hypertension. Cerebral autoregulation, however, may be disturbed in this population, raising the possibility that TCD velocities may be elevated by induced hypertension. To study this possibility, we performed continuous TCD monitoring of the middle cerebral artery during the induction and withdrawal of induced hypertension in patients after subarachnoid hemorrhage.

Methods—Twenty-eight patients were studied during the induction and withdrawal of hypertension using primarily phenylephrine. Continuous monitoring was performed on the middle cerebral artery with the highest flow velocity. Treatment was based on rising TCD velocities or clinical evidence for cerebral vasospasm. Mean arterial pressure and mean TCD velocities were recorded every minute. A change of >15% from starting TCD values was considered significant. Cerebral autoregulation was calculated as a percentage of intact autoregulation. Patients were subsequently divided into groups of disturbed and intact autoregulation.

Results—In 10 of 19 patients (53%), TCD velocities changed by >15% and paralleled changes in mean arterial pressure. This directly altered the TCD interpretation of the grade of vasospasm in 7 of 19 patients (36%). Three additional patients had smaller absolute changes in TCD velocities. No clinical difference could be identified between patients with disturbed and intact autoregulation.

Conclusions—In patients with disturbed autoregulation after subarachnoid hemorrhage, induced hypertension can alter cerebral blood flow velocities. The level of autoregulation needs to be considered when interpreting TCD velocities in patients after subarachnoid hemorrhage.

Key Words: ultrasonography, Doppler • subarachnoid hemorrhage • hypertension

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