. 2019 Aug 15;32(3):742–754. doi: 10.1007/s12028-019-00809-1

Table 3.

Changes in imaging before and after sodium nitroprusside

Patient	TCD cm/s mean	CTA/CTP prior to SNP	Antihypertensive after SNP	SNP dose	DSA post-SNP
1	MCA L 290, ACA L stump	Mean transit time + time to peak prolonged in left MCA/ACA prolonged, no infarction	150 mg Urapidil	3 × 7 mg	Punctual stenosis in the left MCA (80%) and ACA 85%, ICA 60%, no remaining perfusion disturbance
2	MCA L 290, MCA R filiform, bilateral stump in the ACA	Massive prolongation of mean transit time + time to peak bifrontal, massive vasospasm with narrowing the MCA and the ACA about 95%	100 mg Propofol 300 mg Urapidil	3 × 6 + 8 + 10 mg and high-dose Molsidomine	MCA 30% narrowing, ACA R punctual 90%, ACA L 50% narrowing no new perfusion arrest
3	NA	Both MCA narrowing 70%, mean transit time + time to peak prolonged, CBF reduced in left MCA/ACA territories, no infarction	40 mg Urapidil 250 mg Propofol	2 × 5 mg + 7 mg SNP	No constriction > 50%, no perfusion disorder

Patient

TCD cm/s mean

CTA/CTP prior to SNP

Antihypertensive after SNP

SNP dose

DSA post-SNP

MCA L 290, ACA L stump

Mean transit time + time to peak prolonged in left MCA/ACA prolonged, no infarction

150 mg Urapidil

3 × 7 mg

Punctual stenosis in the left MCA (80%) and ACA 85%, ICA 60%, no remaining perfusion disturbance

MCA L 290, MCA R filiform, bilateral stump in the ACA

Massive prolongation of mean transit time + time to peak bifrontal, massive vasospasm with narrowing the MCA and the ACA about 95%

100 mg Propofol

300 mg Urapidil

3 × 6 + 8 + 10 mg and high-dose Molsidomine

MCA 30% narrowing, ACA R punctual 90%, ACA L 50% narrowing no new perfusion arrest

Both MCA narrowing 70%, mean transit time + time to peak prolonged, CBF reduced in left MCA/ACA territories, no infarction

40 mg Urapidil

250 mg Propofol

2 × 5 mg + 7 mg SNP

No constriction > 50%, no perfusion disorder

These examples illustrate the relationship between transcranial Doppler ultrasonography and CT diagnostics (CT perfusion and CT angiography) before sodium nitroprusside application, the amount of antihypertensives required after sodium nitroprusside application to control evoked systemic hypertension and the subsequent alleviation of vasospasm on digital subtraction arteriography

2: After unintended Molsidomine interruption

ACA anterior cerebral artery, CTA CT angiography, CTP CT perfusion, DSA digital substraction angiography, MCA middle cerebral artery, NA not applicable, SNP sodium nitro prusside, TCD transcranial doppler sonography