Objective: To investigate the characteristics of transcranial Doppler variables in the acute stage of intracerebral hemorrhage (ICH) and its relationship with 14-day death and outcomes at 90 day after onset.
Methods: Ninety first-time supratentorial nontraumatic ICH patients were prospectively included. Computed tomography and transcranial Doppler examinations were performed on the first, third, seventh, and fourteenth day after onset. Transcranial Doppler variables were obtained from bilateral middle cerebral arteries. The relationship between ICH outcome and the following variables were analyzed: systolic (V(s)), diastolic (V(d)), mean (V(m)) velocities, and pulsatiliy index (PI) from affected and unaffected hemispheres.
Results: Fourteen (15.6%) patients died within 14 days after onset of ICH. The stepwise logistic regression analyses proved presence of intraventricular hemorrhage (OR: 11.91; 95%CI: 1.62-87.42) and PI from unaffected hemisphere (OR: 1.64; 95%CI: 1.19-2.25) to be independent predictors of 14-day death. Forty-eight of the 90 ICH patients performed the transcranial Doppler monitoring at all four time points. V(m) from both hemispheres decreased gradually within 14 days after onset. Among the 48 patients, 22 patients were dependent (modified Rankin Scale ≥ 3) at 90 days after onset. Compared with patients who were independent at 90 days, V(d) (F = 4.98, P = 0.03) and V(m) (F = 7.30, P<0.01) from unaffected hemisphere were significantly lower, while the PI was significantly higher in patients who were dependent (F = 9.84, P<0.01).
Conclusions: Presence of intraventricular hemorrhage and PI from unaffected hemisphere proved to be independent predictors of 14-day death. Sustained persistent decreases in V(d) and V(m) and increases in PI from the unaffected hemisphere during the acute stage may be related with dependency at 90 days.