Neurocritical Care Copyright © 2007 Humana Press Inc. All rights of any nature whatsoever are reserved. ISSN 1541-6933/07/6:40–44 ISSN 1556-0961 (Online) DOI: 10.1385/Neurocrit. Care 2007;06:40–44 Practical Pearl Perfusion CT to Evaluate the Effect of Transluminal Angioplasty on Cerebral Perfusion in the Treatment of Vasospasm After Subarachnoid Hemorrhage Charles B. L. M. Majoie,1 Leonard J. van Boven,1 Diederik van de Beek,2,* Henk W. Venema,1,3 and Willem J. van Rooij4 1Department of Radiology, 2Neurology, and 3Medical Physics, Academic Medical Center, University of Amsterdam, Amsterdam; the 4Department of Radiology, St. Elisabeth Hospital,Tilburg, the Netherlands *Correspondence and Reprint Requests to: Diederik van de Beek Department of Neurology Academic Medical Center, University of Amsterdam P.O. Box 22700, 1100 DE Amsterdam, The Netherlands E-mail d.vandebeek@amc.uva.nl Abstract Introduction: Delayed ischemic neurologic deficits secondary to vasospasm are a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Treatment of vasospasm after SAH is associated with complications, and reliable techniques for evaluating effects of treatment of vasospasm in such patients are warranted. We present the use of perfusion computed tomography (PTC) to evaluate the effect of transluminal percutaneous angioplasty in a with SAH and vasospasm-induced ischemia. Methods: Dynamic PCT with deconvolution produced maps of time-to-peak, mean transit time, regional cerebral blood flow, and regional cerebral blood volume, with a computerized automated map of the infarct and penumbra. CT scanners with quadruple detector array were used before and after angioplasty. Results: Before angioplasty and intraarterial papaverine, PCT showed normal to decreased cerebral blood flow and increased cerebral blood volume and mean transit time in the middle cerebral artery territory of the left hemisphere. After angioplasty and intraarterial papaverine, PCT showed normalization of perfusion parameters. Conclusion: PCT can be a useful technique in monitoring angioplasty treatment effects in patients with vasospasm after SAH. Key Words: Subarachnoid hemorrhage; perfusion CT; angioplasty; vasospasm. (Neurocrit. Care 2007;06:40–44) Introduction Delayed ischemic neurologic deficits sec- ondary to vasospasm are a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH) (1). The development of vasospasm can be recognized by neurologic deterioration in combination with radiologi- cal techniques, such as conventional digital subtraction angiography (DSA), transcranial Doppler (TCD) ultrasound, positron emis- sion tomography (PET), single-photon emis- sion computer tomography (SPECT), and single-slice perfusion computed tomographic technique (Xe-CT) (1–6). Two recent studies showed that perfusion CT (PCT) also re- presents an accurate screening test in pa- tients with suspected vasospasm, although further refinements are needed before routine recommendation (6,7). Once symptomatic vasospasm is evident (with focal neuro- logic signs), hemodynamic augmentation is widely employed, although definitive evi- dence for this therapy is still lacking (1,8,9). Patients whose condition does not improve 40