Changes of cerebral haemodynamics during rebleeding subsequent to subarachnoid haemorrhage with vasospasm.

A 40-year old patient with spontaneous subarachnoid haemorrhage and vasospasm in whom an acute rebleeding occurred during transcranial Doppler ultrasonography monitoring is reported. The Doppler recordings of the middle cerebral artery displayed an extreme modification in their configuration in the form of an orthograde systolic flow component with zero diastolic flow or an oscillating flow immediately after occurrence of rebleeding. Reoccurrence of a diastolic flow component in still markedly raised cerebrovascular resistance index could be demonstrated a short time later. Rebleeding in subarachnoid haemorrhage with preexisting vasospasm leads to a severe temporary disturbance of cerebral perfusion. The vasospasm is likely to lead to a delayed normalization of perfusion and thus to prolonged ischaemia.