Ultrasound Perfusion Imaging After Aneurysmal Subarachnoid Hemorrhage

Ultrasound Perfusion Imaging After Aneurysmal Subarachnoid Hemorrhage

The purpose of this study is to examine wether delayed cerebral ischemia can be predicted by ultrasound brain perfusion imaging in patients with aneurysmal subarachnoid hemorrhage (SAH).

The delayed cerebral ischemia is a main complication in patient with aneurysmal subarachnoid hemorrhage which causes neurological deficit. So far there is no reliable diagnostic tool to predict the appearance of cerebral ischemia.

The causal correlation between presence of cerebral vasospasm measured daily by transcranial Doppler sonography (TCD) and occurrence of cerebral ischemia detected by cranial computed tomography scan (CCT) is not finally verified.

First studies demonstrated that ultrasound perfusion imaging (UPI) allows the detection of perfusion deficits in middle cerebral artery infarction.

The purpose of our study is to evaluate the diagnostic and prognostic value of UPI to predict delayed cerebral ischemia. In our trial we compare parameters of UPI (b= rise rate, A= plateau of acoustic intensity) in patients with aneurysmal subarachnoid hemorrhage with results of follow-up cranial computed tomography scans (CCT), TCD results and clinical outcome.

Inclusion Criteria:

• Aneurysmal subarachnoid hemorrhage, Hunt and Hess 0-5
• Informed consent
• Sufficient transtemporal acoustic window
• First examination within 48h after subarachnoid hemorrhage
• Minimum Age 18 years

Exclusion Criteria:

• Contraindication against computed tomographic scan
• Incompatibility against SonoVue™
• Acute respiratory distress syndrome
• Uncontrollable hypertensive crisis
• Severe pulmonary disease(pulmonary hypertension > 90 mmHg)
• acute severe cardiac insufficiency (New York Heart Association IV)
• known right-left-shunt
• pregnancy and breastfeeding
• Substance dependence