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. 2020 Nov 23:2020:8874605.
doi: 10.1155/2020/8874605. eCollection 2020.

Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers

Ahmed Esmael  1 , Tamer Belal  1 , Khaled Eltoukhy  1
Affiliations

Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers

Ahmed Esmael et al. Stroke Res Treat. .

Abstract

Methods: Prospective study included 40 cases with acute aSAH. Initial evaluation by Glasgow Coma Scale (GCS) and the severity of aSAH was detected by both the clinical Hunt and Hess and radiological Fisher's grading scales. TCD was done for all patients five times within 10 days measuring the mean flow velocities (MFVs) of cerebral arteries. At the 3-month follow-up, patients were classified into two groups according to Montreal Cognitive Assessment (MoCA) scale: the first group was 31 cases (77.5%) with intact cognitive functions and the other group was 9 cases (22.5%) with impaired cognition.

Results: Patients with impaired cognitive functions showed significantly lower mean GCS (p = 0.03), significantly higher mean Hunt and Hess scale grades (p = 0.04), significantly higher mean diabetes mellitus (DM) (p = 0.03), significantly higher mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p = 0.02 and p = 0.005, respectively), and significantly higher MFVs measured within the first 10 days. The patients with cognitive impairment were accompanied by a higher incidence of hydrocephalus (p = 0.01) and a higher incidence of delayed cerebral ischemia (DCI) (p < 0.001). Logistic regression analysis detected that MFV ≥ 86 cm/s in the middle cerebral artery (MCA), MFV ≥ 68 cm/s in the anterior cerebral artery (ACA), and MFV ≥ 45 cm/s in the posterior cerebral artery (PCA) were significantly associated with increased risk of cognitive impairment.

Conclusion: Cognitive impairment after the 3-month follow-up phase in aSAH patients was 22.5%. Acute hydrocephalus and DCI are highly associated with poor cognitive function in aSAH. Increased MFV is a strong predictor for poor cognitive function in aSAH. This trial is registered with NCT04329208.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this article.

Figures

Figure 1
Figure 1
Study flow chart of patients included in the final analysis.
Figure 2
Figure 2
Diagnosis of aSAH by brain CT scan and digital subtraction angiography. (a) Brain CT scan was done revealing subarachnoid hemorrhage. Hunt and Hess scale was III. (b) Digital subtraction angiography was done showing the left MCA aneurysm.
Figure 3
Figure 3
Correlation of mean flow velocity and MoCA.
Figure 4
Figure 4
The average MFVs of the cerebral arteries measured within the first 10 days in aSAH patients with cognitive impairment and aSAH patients with intact cognition.
Figure 5
Figure 5
MFV cut-off values detected by the ROC curve.
See this image and copyright information in PMC

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