Transcranial doppler study in the patients with ruptured cerebral aneurysm

의학과/석사[한글] 뇌동맥류 파열에 의한 지주막하 출혈의 가장 중요한 합병증 중의 하나인 뇌혈관 연축은 지연성 뇌허혈증 및 경색을 초래하여 유병률을 높이는 요인이 되어왔으나 조기에 뇌혈관 연축을 진단하는데 어려움이 많았다. 최근 경두개 도플러 검사로써 뇌기저부 Willis환의 주요 뇌동맥에서 혈류속도를 측정할 수 있게 됨으로써 간접적으로 뇌혈관연축의 정도 및 범위를 알수 있게 되었다. 이에 저자는 1990년 8월 1일부터 1990년 10월 31일까지 뇌동맥류성 지주막하출혈로 연세대학교 의과대학 부속 세브란스병원 신경외과에 입원, 치료받은 환자중 15예에서 양측 전대뇌동맥 및 중대뇌동맥에 대한 경두개 도플러 검사를 전향적으로 시행하여 경두개 도플러 검사가 뇌혈관연축으로 인한 지연성 뇌허혈증 및 경색의 조기진단에 어떤 효과가 있는지 알아보고자 하였다. 1. 대체로 출혈후 3일 이내에 이미 혈류속도는 증가소견을 보이면서 출혈후 3일에서 7내지 8일까지 지속적인 증가를 보였고 그 이후 서서히 정상화 되었다. 2. 혈류속도의 증가는 항상 뇌혈관연축으로 인한 임상증세의 발현보다 앞서서 나타나며, 혈류속도가 조기에 급격히 증가하는 소견을 보였을 때는 뇌혈관연축의 발생 가능성이 높은 것으로 생각되었다. 3. 출혈후 3일 이내에 촬영한 뇌전산화단층촬영에서 지주막하강의 혈괴가 두꺼울수록 혈류속도의 증가도 심하였다. 4. 임상적으로 양호한 상태임에도 불구하고 혈류속도가 비교적 급속도로 증가추세를 보일 때 미리 뇌혈관연축에 대한 적극적인 치료를 시행함으로써 아무런 신경학적 이상의 발생없이 경과하거나 발생했더라도 경미하게 지나가는 소견을 보였다. 이상의 결과로 보아 경두개 도플러 검사가 뇌혈관연축에 의한 지연성 뇌허혈증 및 경색의 예방에 중요한 지침이 될 것으로 생각되었다. Transcranial Doppler study in the patients with ruptured cerebral aneurysm Yong Soon Hwang Department of Medical Science The Graduate School Yonsei University (Directed by Prof. Kyu Chang Lee, M.D., D.M.Sc.) The author performed prospectively the transcranial doppler monitoring of bilateral anterior and middle cerebral arteries in 15 patients with ruptured cerebral aneurysm who were admitted to the Department of Neurosurgery, Yonsei University, Severance Hospital from August 1, 1990 to October 30, 1990. The entry criteria for the study were confined to the patients who were admitted within 3 days after bleeding and were clincial grade Ⅲ or better on admission. Results of the study are summarized as follows ; 1. Mean frequency shirts of bilateral anterior and middle cerebral arteries were increased immediately after ictus and showed continuous further elevation between the 3rd and 8th rupture days. After that, they slowly normalized. 2. Increase of frequency shift preceded clinical ischemic symptoms and an early steep increase of frequency shift was correlated to a high chance for suffering delayed ischemic deficits. 3. Thick clots in subarachnoid cisterns which shown in CT scans taken within the third rupture day were correlated to a severe increase of frequency shifts. 4. Aggressive treatment was done in asymptomatic patients who showed relatively rapid increase of frequency shifts, and they had showed no or transient mild ischemic symptoms. It is concluded that the transcranial Doppler monitoringe study is invaluable for the detection of impending delayed ischemic deficits and for monitoring the course of the cerebral vasospasm. [영문] The author performed prospectively the transcranial doppler monitoring of bilateral anterior and middle cerebral arteries in 15 patients with ruptured cerebral aneurysm who were admitted to the Department of Neurosurgery, Yonsei University, Severance Hospital from August 1, 1990 to October 30, 1990. The entry criteria for the study were confined to the patients who were admitted within 3 days after bleeding and were clincial grade Ⅲ or better on admission. Results of the study are summarized as follows ; 1. Mean frequency shirts of bilateral anterior and middle cerebral arteries were increased immediately after ictus and showed continuous further elevation between the 3rd and 8th rupture days. After that, they slowly normalized. 2. Increase of frequency shift preceded clinical ischemic symptoms and an early steep increase of frequency shift was correlated to a high chance for suffering delayed ischemic deficits. 3. Thick clots in subarachnoid cisterns which shown in CT scans taken within the third rupture day were correlated to a severe increase of frequency shifts. 4. Aggressive treatment was done in asymptomatic patients who showed relatively rapid increase of frequency shifts, and they had showed no or transient mild ischemic symptoms. It is concluded that the transcranial Doppler monitoringe study is invaluable for the detection of impending delayed ischemic deficits and for monitoring the course of the cerebral vasospasm.restrictio