Objective: To evaluate, using transcranial Doppler, changes in parameters in patients with cerebral hematoma, as compared with controls, for detection of possible regional hypoperfusion.
Patients and methods: We studied 24 patients with cerebral hematomas and 15 healthy volunteers. The volume of the hematoma and the hypodense area was determined by computerized axial tomography of the skull at the time of admission. The average speed and index of pulsation of the anterior, middle and posterior cerebral arteries were measured in both hemispheres using transcranial Doppler within the first 100 hours. The differences between the averages were analysed using the ANOVA test and the correlations with Pearson's coefficient of correlation.
Results: The average speeds, except in the anterior cerebral artery, were lower in both hemispheres in the patients than in the controls (p < 0.001). There were interhemispherical differences in the average speeds in the patients (p = 0.06). The indices of pulsatility were greater in both hemispheres in the patients than in the controls (p < 0.001). These differences were independent of age, sex and arterial blood pressure. The average speed in the ipsilateral middle cerebral artery showed excellent correlation with the size of the hypodense area (r = -0.92) and the hematoma (r = -0.89). The indices of pulsatility showed little correlation with the size of the lesion. There was moderate correlation between transcranial Doppler and clinical scales.
Conclusion: Transcranial Doppler detects cerebral hypoperfusion in patients with hematoma. The excellent correlation of the average speed in the middle cerebral artery with the size of the lesion and the low correlation of the indices of pulsatility, which did not show interhemispherical asymmetry, suggest that the mechanisms of hipoperfusion are different from the intracranial hypertension.