{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:25:51Z","timestamp":1769729151833,"version":"3.49.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,7,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n Effective management of patients with aneurysmal subarachnoid hemorrhage (aSAH) demands vigilant monitoring and treatment, given the risks of complications such as cerebral vasospasm and delayed ischemic neurological deficits (DINDs). Transcranial transmission ultrasound (TTUS) is a well-established technique for assessing brain pulsatility. This pilot study aims to explore the utility of TTUS in detecting impaired intracerebral blood flow associated with DINDs.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors examined 2 male patients, ages 45 and 52 years, with aSAH Hunt and Hess grades 4 and 2, respectively, who developed DINDs during their clinical course. Simultaneous recordings of arterial blood pressure, heart rate, and TTUS measurements were obtained in the intensive care unit. TTUS analysis revealed abnormal arrhythmic wave patterns during DIND episodes, whereas baseline measurements on DIND-free days showed no abnormalities. Following endovascular spasmolysis, TTUS demonstrated a normalization of abnormal waves, returning to baseline levels, alongside the resolution of neurological symptoms.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n TTUS, a noninvasive method for assessing brain pulsatility, shows promise as a novel tool for monitoring aSAH patients, potentially aiding in prompt diagnostics and additional therapeutic interventions. Its capacity to provide further insights for individuals at risk of delayed cerebral ischemia warrants further investigation in clinical studies.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24146<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24146","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T01:50:54Z","timestamp":1721785854000},"source":"Crossref","is-referenced-by-count":0,"title":["Application of transcranial transmission ultrasound in the detection of vasospasm in patients with aneurysmal subarachnoid hemorrhage: illustrative cases"],"prefix":"10.3171","volume":"8","author":[{"given":"Maximilian","family":"Schwendner","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"},{"name":"Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonie","family":"Kram","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"},{"name":"Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haosu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"},{"name":"Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Kathrin","family":"Joerger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raimunde","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Negwer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Wostrack","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"7","key":"bib1","series-title":"Lancet Neurol","first-page":"635","article-title":"Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis","volume":"8","author":"Nieuwkamp","year":"2009","unstructured":"Nieuwkamp DJSetz LEAlgra ALinn FHde Rooij NKRinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8(7):635-642."},{"issue":"5","key":"bib2","series-title":"Neurology","first-page":"481","article-title":"Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage","volume":"80","author":"Korja","year":"2013","unstructured":"Korja MSilventoinen KLaatikainen TJousilahti PSalomaa VKaprio J. Cause-specific mortality of 1-year survivors of subarachnoid hemorrhage. Neurology. 2013;80(5):481-486."},{"issue":"6","key":"bib3","series-title":"Stroke","first-page":"1963","article-title":"Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?","volume":"40","author":"Frontera","year":"2009","unstructured":"Frontera JAFernandez ASchmidt JM, et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?Stroke. 2009;40(6):1963-1968."},{"issue":"2","key":"bib4","series-title":"Neurol Ther","first-page":"371","article-title":"Clinical burden of angiographic vasospasm and its complications after aneurysmal subarachnoid hemorrhage: a systematic review","volume":"12","author":"Chalet","year":"2023","unstructured":"Chalet FXBriasoulis OManalastas EJTalbot DAThompson JCMacdonald RL. Clinical burden of angiographic vasospasm and its complications after aneurysmal subarachnoid hemorrhage: a systematic review. Neurol Ther. 2023;12(2):371-390."},{"issue":"4","key":"bib5","series-title":"Stroke","first-page":"562","article-title":"Cerebral vasospasm following aneurysmal subarachnoid hemorrhage","volume":"16","author":"Kassell","year":"1985","unstructured":"Kassell NFSasaki TColohan ARNazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke. 1985;16(4):562-572."},{"issue":"1","key":"bib6","series-title":"Nat Rev Neurol","first-page":"44","article-title":"Delayed neurological deterioration after subarachnoid haemorrhage","volume":"10","author":"Macdonald","year":"2014","unstructured":"Macdonald RL. Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol. 2014;10(1):44-58."},{"issue":"3","key":"bib7","series-title":"Neurology","first-page":"329","article-title":"Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations","volume":"36","author":"Hijdra","year":"1986","unstructured":"Hijdra AVan Gijn JStefanko SVan Dongen KJVermeulen MVan Crevel H. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. 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J Clin Neurosci. 2021;88:237-242."},{"issue":"2","key":"bib12","series-title":"Neurocrit Care","first-page":"211","article-title":"Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society\u2019s Multidisciplinary Consensus Conference","volume":"15","author":"Diringer","year":"2011","unstructured":"Diringer MNBleck TPClaude Hemphill JIII, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society\u2019s Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15(2):211-240."},{"issue":"10","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"1853","article-title":"Diagnostic accuracy of CT angiography and CT perfusion for cerebral vasospasm: a meta-analysis","volume":"31","author":"Greenberg","year":"2010","unstructured":"Greenberg EDGold RReichman M, et al. Diagnostic accuracy of CT angiography and CT perfusion for cerebral vasospasm: a meta-analysis. AJNR Am J Neuroradiol. 2010;31(10):1853-1860."},{"issue":"2","key":"bib14","series-title":"J Neurosurg","first-page":"220","article-title":"Effects of balloon angioplasty on perfusion- and diffusion-weighted magnetic resonance imaging results and outcome in patients with cerebral vasospasm","volume":"105","author":"Beck","year":"2006","unstructured":"Beck JRaabe ALanfermann H, et al. Effects of balloon angioplasty on perfusion- and diffusion-weighted magnetic resonance imaging results and outcome in patients with cerebral vasospasm. J Neurosurg. 2006;105(2):220-227."},{"issue":"5","key":"bib15","series-title":"J Neurosurg","first-page":"1257","article-title":"Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis","volume":"124","author":"Kumar","year":"2016","unstructured":"Kumar GShahripour RBHarrigan MR. Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2016;124(5):1257-1264."},{"issue":"7","key":"bib16","series-title":"Intensive Care Med","first-page":"1088","article-title":"The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage","volume":"29","author":"Mascia","year":"2003","unstructured":"Mascia LFedorko LterBrugge K, et al. The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. 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Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391-2395."},{"issue":"4","key":"bib19","series-title":"Neurosurgery","first-page":"853","article-title":"Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients","volume":"71","author":"Zweifel","year":"2012","unstructured":"Zweifel CCzosnyka MCarrera Ede Riva NPickard JDSmielewski P. Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients. Neurosurgery. 2012;71(4):853-861."},{"issue":"15","key":"bib20","series-title":"J Am Heart Assoc","first-page":"e021845","article-title":"Pathophysiology of delayed cerebral ischemia after subarachnoid hemorrhage: a review","volume":"10","author":"Dodd","year":"2021","unstructured":"Dodd WSLaurent DDumont AS, et al. Pathophysiology of delayed cerebral ischemia after subarachnoid hemorrhage: a review. J Am Heart Assoc. 2021;10(15):e021845."},{"issue":"7","key":"bib1","series-title":"Lancet Neurol","first-page":"635","article-title":"Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis","volume":"8","author":"Nieuwkamp","year":"2009","unstructured":"Nieuwkamp DJSetz LEAlgra ALinn FHde Rooij NKRinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. 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Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?Stroke. 2009;40(6):1963-1968."},{"issue":"2","key":"bib4","series-title":"Neurol Ther","first-page":"371","article-title":"Clinical burden of angiographic vasospasm and its complications after aneurysmal subarachnoid hemorrhage: a systematic review","volume":"12","author":"Chalet","year":"2023","unstructured":"Chalet FXBriasoulis OManalastas EJTalbot DAThompson JCMacdonald RL. Clinical burden of angiographic vasospasm and its complications after aneurysmal subarachnoid hemorrhage: a systematic review. Neurol Ther. 2023;12(2):371-390."},{"issue":"4","key":"bib5","series-title":"Stroke","first-page":"562","article-title":"Cerebral vasospasm following aneurysmal subarachnoid hemorrhage","volume":"16","author":"Kassell","year":"1985","unstructured":"Kassell NFSasaki TColohan ARNazar G. Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke. 1985;16(4):562-572."},{"issue":"1","key":"bib6","series-title":"Nat Rev Neurol","first-page":"44","article-title":"Delayed neurological deterioration after subarachnoid haemorrhage","volume":"10","author":"Macdonald","year":"2014","unstructured":"Macdonald RL. Delayed neurological deterioration after subarachnoid haemorrhage. Nat Rev Neurol. 2014;10(1):44-58."},{"issue":"3","key":"bib7","series-title":"Neurology","first-page":"329","article-title":"Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations","volume":"36","author":"Hijdra","year":"1986","unstructured":"Hijdra AVan Gijn JStefanko SVan Dongen KJVermeulen MVan Crevel H. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. Neurology. 1986;36(3):329-333."},{"key":"bib8","series-title":"Neurol Res Int","first-page":"462491","article-title":"Medical management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a review of current and emerging therapeutic interventions","volume":"2013","author":"Adamczyk","year":"2013","unstructured":"Adamczyk PHe SAmar APMack WJ. Medical management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a review of current and emerging therapeutic interventions. Neurol Res Int. 2013;2013:462491."},{"issue":"1","key":"bib9","series-title":"Crit Care","first-page":"277","article-title":"Management of delayed cerebral ischemia after subarachnoid hemorrhage","volume":"20","author":"Francoeur","year":"2016","unstructured":"Francoeur CLMayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care. 2016;20(1):277."},{"issue":"1","key":"bib10","series-title":"Stroke","first-page":"43","article-title":"Delayed cerebral ischemia after subarachnoid hemorrhage: a systematic review of clinical, laboratory, and radiological predictors","volume":"44","author":"de Rooij","year":"2013","unstructured":"de Rooij NKRinkel GJDankbaar JWFrijns CJ. Delayed cerebral ischemia after subarachnoid hemorrhage: a systematic review of clinical, laboratory, and radiological predictors. Stroke. 2013;44(1):43-54."},{"key":"bib11","series-title":"J Clin Neurosci","first-page":"237","article-title":"Acute hyponatremia after aneurysmal subarachnoid hemorrhage: frequency, treatment, and outcome","volume":"88","author":"Kieninger","year":"2021","unstructured":"Kieninger MKerscher CBr\u00fcndl E, et al. Acute hyponatremia after aneurysmal subarachnoid hemorrhage: frequency, treatment, and outcome. J Clin Neurosci. 2021;88:237-242."},{"issue":"2","key":"bib12","series-title":"Neurocrit Care","first-page":"211","article-title":"Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society\u2019s Multidisciplinary Consensus Conference","volume":"15","author":"Diringer","year":"2011","unstructured":"Diringer MNBleck TPClaude Hemphill JIII, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society\u2019s Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15(2):211-240."},{"issue":"10","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"1853","article-title":"Diagnostic accuracy of CT angiography and CT perfusion for cerebral vasospasm: a meta-analysis","volume":"31","author":"Greenberg","year":"2010","unstructured":"Greenberg EDGold RReichman M, et al. Diagnostic accuracy of CT angiography and CT perfusion for cerebral vasospasm: a meta-analysis. AJNR Am J Neuroradiol. 2010;31(10):1853-1860."},{"issue":"2","key":"bib14","series-title":"J Neurosurg","first-page":"220","article-title":"Effects of balloon angioplasty on perfusion- and diffusion-weighted magnetic resonance imaging results and outcome in patients with cerebral vasospasm","volume":"105","author":"Beck","year":"2006","unstructured":"Beck JRaabe ALanfermann H, et al. Effects of balloon angioplasty on perfusion- and diffusion-weighted magnetic resonance imaging results and outcome in patients with cerebral vasospasm. J Neurosurg. 2006;105(2):220-227."},{"issue":"5","key":"bib15","series-title":"J Neurosurg","first-page":"1257","article-title":"Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis","volume":"124","author":"Kumar","year":"2016","unstructured":"Kumar GShahripour RBHarrigan MR. Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2016;124(5):1257-1264."},{"issue":"7","key":"bib16","series-title":"Intensive Care Med","first-page":"1088","article-title":"The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage","volume":"29","author":"Mascia","year":"2003","unstructured":"Mascia LFedorko LterBrugge K, et al. The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. 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Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391-2395."},{"issue":"4","key":"bib19","series-title":"Neurosurgery","first-page":"853","article-title":"Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients","volume":"71","author":"Zweifel","year":"2012","unstructured":"Zweifel CCzosnyka MCarrera Ede Riva NPickard JDSmielewski P. Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients. Neurosurgery. 2012;71(4):853-861."},{"issue":"15","key":"bib20","series-title":"J Am Heart Assoc","first-page":"e021845","article-title":"Pathophysiology of delayed cerebral ischemia after subarachnoid hemorrhage: a review","volume":"10","author":"Dodd","year":"2021","unstructured":"Dodd WSLaurent DDumont AS, et al. Pathophysiology of delayed cerebral ischemia after subarachnoid hemorrhage: a review. 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