Non-detection of Acute Angiography-induced Cerebral Vasospasmby Transcranial Doppler Sonography amongst Patients with Subarachnoid Haemorrhage in Kelantan

Abstract

Dear Editor,
We conducted a study to determine the proportion of patients with spontaneous subarachnoid haemorrhage (SAH) who developed cerebral vasospasm (CVS) following cerebral intraarterial digital subtraction angiography (IADSA) and to identify the angiography related risk factors that cause acute CVS following cerebral IADSA by using transcranial Doppler (TCD). A prospective study was conducted over an 18-month period from May 2007 until October 2008 at the Hospital 
Universiti Sains Malaysia (HUSM). A total of 8 patients above 12 years of age (5 males and 3 females, mean age ± SD: 54.1 ± 13.1) who presented with spontaneous SAH and fulfilled the inclusion criteria were enrolled into this study. Intra-arterial cerebral catheter angiography, even though it is 
the gold standard modality for assessment of the cause of SAH, is an invasive test with potentially significant neurological complications, with 0.07% to 0.3% risk of permanent stroke and an overall 1.8% risk of systemic complication (1). In patients with intracranial haemorrhage, particularly 
SAH, it is very difficult to determine whether the development of the neurological complications is part of the natural course of the disease or if it is caused by the diagnostic angiographic examination, which was performed before or during the time when CVS commonly occurs. This 
raises the question whether cerebral angiography itself could be one of the multiple factors causing the development of CVS among patients with SAH.