Role of Acetazolamide Brain SPECT in the Evaluation of Delayed Ischemic Neurological Deficits Following Aneurysmal Subarachnoid Hemorrhage.

Joong, Hyoung; Kim, Eun Young; Ha, Yoon; Youn, Seung Hwan; Park, Hyung Chun; Park, Hyeon Seon

Original Article

Journal of Korean Neurosurgical Society 2004;35(2): 162-167.

Hyoung Joong, Eun Young Kim, Yoon Ha, Seung Hwan Youn, Hyung Chun Park, Hyeon Seon Park

Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea. hspark@inha.ac.kr

ABSTRACT

OBJECTIVE
The purpose of this study is to evaluate the role of acetazolamide brain SPECT in the assessment of delayed ischemic neurological deficits(DINDs) following aneurysmal subarachnoid hemorrhage. METHODS: Prospective analysis of consecutive patients with aneurysmal subarachnoid hemorrhage was made from July 1999 to December 2000. Regular neurological examination and Transcranial Doppler(TCD) monitoring were done for monitoring development of DINDs. Postoperative cerebral angiography and acetazolamide brain SPECT were performed according to our spasm-monitoring algorithm. Correlation of three diagnostic tools with development of DINDs was evaluated and concordance rates between each diagnostic tool were investigated. RESULTS: A total of 65 patients were included. DINDs were developed in 44.6% of patients. Spasm evidences on TCD monitoring, cerebral angiography and acetazolamide brain SPECT were observed in 38.5%, 40.0%, 41.5% of patients. Although there is no statistical significance, acetazolamide brain SPECT was more correlated with DINDs development than other two tools. Spasm evidence on TCD were not proceeded the development of DINDs in 58.6% of patients with DINDs. Concordance rate between acetazolamide brain SPECT and cerebral angiography was highest. However, there are significant numbers of discordance between two tools.
CONCLUSION
Three diagnostic tools are complementary to each other in the assessment of DINDs. However, considering that DINDs is basically attributable to cerebral hemodynamic alteration rather than arterial morphologic change, acetazolamide brain SPECT seems to be the most useful tool in the evaluation of DINDs.

Key Words: Acetazolamide SPECT; Delayed ischemic neurological deficits; Hemodynamic nature; Microcirculation; Leptomeningeal circulation