Uso complementario de Doppler transcraneal y tomografía por perfusión en la hemorragia subaracnoidea aneurismática: serie de 4 casos

Abstract: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for about 5% of cerebrovascular events and is associated with high morbidity and mortality. Its complications include vasospasm and delayed cerebral ischemia (DCI). Transcranial Doppler (TCD) allows for the early detection of macrovasospasm, while cerebral perfusion computed tomography (CTP) provides information on perfusion status and areas at risk of ischemia. In this series of four cases of patients with aSAH treated with endovascular aneurysm exclusion, both methods were used as complementary diagnostic and monitoring tools. TCD allowed for the identification of elevated mean velocities (>120 cm/s) and increases in the Lindegaard index, while CTP showed patterns of hyperemia or hypoperfusion depending on the clinical scenario. Patients with symptomatic vasospasm were managed with targeted hyperdynamic therapy (norepinephrine 0.03–0.04 μg/kg/min; MAP > 90 mmHg), and all received prophylactic oral nimodipine according to the 2023 AHA/ASA guidelines (Class I; Level A); in one case with significant hypoperfusion, chemical and mechanical angioplasty with intra-arterial nimodipine was performed. Three patients were discharged with a modified Rankin Scale of 0 and one with 1, with no associated mortality. Case analysis demonstrates that the integration of TCD and CTP can provide complementary information for the timely detection and management of DCI, suggesting a potential future research direction for their combined use in patients with aSAH.