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Neurosonological studies, specifically transcranial Doppler (TCD) and transcranial color-coded duplex (TCCD), have high level of specificity and sensitivity and they are used as complementary tests for the diagnosis of brain death (BD). A group of experts, from the Neurosonology Department of the Brazilian Academy of Neurology, created a task force to determine the criteria for the following aspects of diagnosing BD in Brazil: the reliability of TCD methodology; the reliability of TCCD methodology; neurosonology training and skills; the diagnosis of encephalic circulatory arrest; and exam documentation for BD. The results of this meeting are presented in the current paper.Key words: transcranial Doppler, encephalic circulatory arrest, brain death. resumo Estudos neurossonológicos, especialmente o Doppler transcraniano (DTC) e o duplex transcraniano codificado a cores (DTCC), apresentam elevados níveis de especificidade e sensibilidade quando utilizados como exames complementares no diagnóstico de morte encefálica (ME). Um grupo de peritos do Departamento Científico de Doppler transcraniano da Academia Brasileira de Neurologia criou uma força-tarefa de forma a determinar os critérios neurossonológicos para os seguintes aspectos no diagnóstico de ME no Brasil: metodologia do DTC; metodologia do DTCC; treinamento e habilidades em Neurossonologia; diagnóstico de parada circulatória encefálica e documentação do exame para a ME. Os resultados deste encontro foram apresentados neste artigo.Palavras-Chave: Doppler transcraniano, parada circulatória encefálica, morte encefálica.

Background: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients’ management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. Summary: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was reviewed and approved by the Executive Committee of the NSRG of the World Federation of Neurology. The main objective of this consensus statement is to establish a standardization of the c-TCD technique and its interpretation, in order to improve the informative quality of the method, resulting in expanding the application of TCD in the clinical setting. These recommendations optimize the comparison of different diagnostic methods and encourage the use of c-TCD for RLS screening and complementary diagnosis in multicenter studies.

Background: Early hospital admission followed by correct diagnosis with minimum delay is a prerequisite for successful new interventions in acute intracerebral hemorrhage (ICH). The aim of this study was to evaluate clinical features associated with early hospital arrival in ICH patients and their influence on the outcome. Methods: Data from all patients arriving within 24 h of the ICH onset were prospectively collected at 2 stroke centers in São Paulo, Brazil. The cutoff of 3 h was chosen to select 2 groups: 0–3 h (early) and >3–24 h (late). Results: We identified 91 ICH patients (mean age 57.9 years, 62% men, 63% white) admitted within the first 24 h of symptom onset between March 2004 and April 2005. Systolic blood pressure, mean arterial pressure and pulse pressure were significantly higher in patients arriving within 3 h. Patients that arrived early also had a higher NIHSS score (p = 0.003), a lower Glasgow Coma Score (p = 0.001) and presence of intraventricular hemorrhage (p = 0.02). Lower ICH scores were more frequent in those that arrived late. Fourteen patients showed hematoma enlargement and the majority of them (n = 13) were admitted within the first 3 h from symptom onset (p = 0.01). Patients who arrived within the 3-hour window had a higher 30-day mortality (p = 0.0008) and a worse Rankin score after 6 months (p = 0.001). Conclusions: Treatment decisions in acute ICH may need to establish new combined approaches to maximize the number of eligible patients for early therapy considering the interactions between independent outcome predictors presented at early onset.