Background: It is not well understood whether age impacts transcranial Doppler (TCD) mean flow velocities (MFVs) in patients with aneurysmal subarachnoid hemorrhage (SAH) with or without delayed cerebral ischemia (DCI). The aim of our study was to analyze the behavior of TCD MFV during the first 7 days after SAH in patients of different ages and correlate them with the occurrence of DCI. Methods: This study is a databank analysis of patients with SAH admitted between 2010 and 2012 in a single center. We analyzed mean MFV of bilateral middle cerebral arteries (MCAs) in all patients enrolled in the study on days 1, 3 and 7. The correlation between age and TCD MFV was analyzed using a univariate linear regression model. Results: Fifty-five patients were studied. Starting on the third day after the bleeding, increasing age was associated with slower MFVs. This trend was not affected by the interrogation of the right or left MCA. After correction to include only patients who developed DCI, the same findings persisted on days 3 and 7. Conclusion: Older age was correlated with a significant decrease on TCD velocities in patients with SAH, even after correction for patients who developed DCI.

Keywords:
Subarachnoid hemorrhage, Intracranial vasospasm, Age groups, Transcranial Doppler sonography
1.
Vergouwen MD: Vasospasm versus delayed cerebral ischemia as an outcome event in clinical trials and observational studies. Neurocrit Care 2011;15:308-311.
2.
Hughes JT, Schianchi PM: Cerebral artery spasm. A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage. J Neurosurg 1978;48:515-525.
3.
Diringer MN, Bleck TP, Claude Hemphill J 3rd, et al: Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit Care 2011;15:211-240.
4.
Fisher CM, Roberson GH, Ojemann RG: Cerebral vasospasm with ruptured saccular aneurysm - the clinical manifestations. Neurosurgery 1977;1:245-248.
5.
Rabinstein AA, Friedman JA, Weigand SD, et al: Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke 2004;35:1862-1866.
6.
Dankbaar JW, Rijsdijk M, van der Schaaf IC, Velthuis BK, Wermer MJ, Rinkel GJ: Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Neuroradiology 2009;51:813-819.
7.
van Gijn J, Kerr RS, Rinkel GJ: Subarachnoid haemorrhage. Lancet 2007;369:306-318.
8.
Charpentier C, Audibert G, Guillemin F, et al: Multivariate analysis of predictors of cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage. Stroke 1999;30:1402-1408.
9.
Aaslid R, Huber P, Nornes H: Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 1984;60:37-41.
10.
White H, Venkatesh B: Applications of transcranial Doppler in the ICU: a review. Intensive Care Med 2006;32:981-994.
11.
Kale SP, Edgell RC, Alshekhlee A, et al: Age-associated vasospasm in aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2013;22:22-27.
12.
Ryttlefors M, Enblad P, Ronne-Engström E, Persson L, Ilodigwe D, Macdonald RL: Patient age and vasospasm after subarachnoid hemorrhage. Neurosurgery 2010;67:911-917.
13.
Torbey MT, Hauser TK, Bhardwaj A, et al: Effect of age on cerebral blood flow velocity and incidence of vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 2001;32:2005-2011.
14.
Demirkaya S, Uluc K, Bek S, Vural O: Normal blood flow velocities of basal cerebral arteries decrease with advancing age: a transcranial Doppler sonography study. Tohoku J Exp Med 2008;214:145-149.
15.
Fisher JP, Hartwich D, Seifert T, et al: Cerebral perfusion, oxygenation and metabolism during exercise in young and elderly individuals. J Physiol 2013;591:1859-1870.
16.
Burch CM, Wozniak MA, Sloan MA, et al: Detection of intracranial internal carotid artery and middle cerebral artery vasospasm following subarachnoid hemorrhage. J Neuroimaging 1996;6:8-15.
17.
Grolimund P, Seiler RW, Aaslid R, Huber P, Zurbruegg H: Evaluation of cerebrovascular disease by combined extracranial and transcranial Doppler sonography. Experience in 1,039 patients. Stroke 1987;18:1018-1024.
18.
Sloan MA, Haley EC Jr, Kassell NF, et al: Sensitivity and specificity of transcranial Doppler ultrasonography in the diagnosis of vasospasm following subarachnoid hemorrhage. Neurology 1989;39:1514-1518.
19.
Macdonald RL: Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol 2014;10:44-58.
20.
Alexandrov AV, Sloan MA, Wong LK, et al: Practice standards for transcranial Doppler ultrasound: part I - test performance. J Neuroimaging 2007;17:11-18.
21.
Frontera JA, Fernandez A, Schmidt JM, et al: Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke 2009;40:1963-1968.
22.
Kasius KM, Frijns CJ, Algra A, Rinkel GJ: Association of platelet and leukocyte counts with delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis 2010;29:576-583.
23.
Kooijman E, Nijboer CH, van Velthoven CT, et al: Long-term functional consequences and ongoing cerebral inflammation after subarachnoid hemorrhage in the rat. PLoS One 2014;9:e90584.
24.
Maiuri F, Gallicchio B, Donati P, Carandente M: The blood leukocyte count and its prognostic significance in subarachnoid hemorrhage. J Neurosurg Sci 1987;31:45-48.
25.
McMahon CJ, Hopkins S, Vail A, et al: Inflammation as a predictor for delayed cerebral ischemia after aneurysmal subarachnoid haemorrhage. J Neurointerv Surg 2013;5:512-517.
26.
Provencio JJ: Inflammation in subarachnoid hemorrhage and delayed deterioration associated with vasospasm: a review. Acta Neurochir Suppl 2013;115:233-238.
27.
Boecher-Schwarz HG, Ungersboeck K, Ulrich P, Fries G, Wild A, Perneczky A: Transcranial Doppler diagnosis of cerebral vasospasm following subarachnoid haemorrhage: correlation and analysis of results in relation to the age of patients. Acta Neurochir (Wien) 1994;127:32-36.
28.
Oka K, Kuromatsu C, Takaki T, Maeyama R, Fukui M, Kitamura K: [Therapeutic problems in aged patients with intracranial aneurysms]. No Shinkei Geka 1987;15:375-379.
29.
Fabiani M, Low KA, Tan CH, et al: Taking the pulse of aging: mapping pulse pressure and elasticity in cerebral arteries with optical methods. Psychophysiology 2014;51:1072-1088.
30.
Fonck E, Feigl GG, Fasel J, et al: Effect of aging on elastin functionality in human cerebral arteries. Stroke 2009;40:2552-2556.
31.
Singer J, Trollor JN, Baune BT, Sachdev PS, Smith E: Arterial stiffness, the brain and cognition: a systematic review. Ageing Res Rev 2014;15:16-27.
32.
Zhu YS, Tseng BY, Shibata S, Levine BD, Zhang R: Increases in cerebrovascular impedance in older adults. J Appl Physiol (1985) 2011;111:376-381.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.