Clinical Applications of Ultrasonography in Neurocritically Ill Patients

Abstract

Ultrasonography is part of the multimodal monitoring of the neurocritical patient. Through transcranial color Doppler ultrasound, carotid-color Doppler ultrasound, and ocular ultrasound it is possible to diagnose and monitor a multitude of pathological conditions, such as cerebrovascular events, vasospasm, Terson syndrome, carotid atheromatosis, and brain death. Furthermore, these techniques enable the monitoring of the intracranial pressure, the cerebral perfusion pressure, and the midline deviation, which allows us to understand the patient’s neurocritical pathology at their bedside, in a noninvasive way. Although none of these tools have yet been shown to improve patient prognosis, the dissemination of knowledge and management of neurovascular ultrasonography could significantly improve the comprehensive management of neurocritical patients.

Negative-pressure helmet restores cerebral hemodynamic parameters in sinking skin flap syndrome: a case report

“…Nowadays, assessment of CBF using TCD is being performed when facing rapid neurological changes following extra-dural or subarachnoid hematomas or even after cerebral aneurysm rupture [14,15]. Nevertheless, studies have demonstrated a good correla-tion between changes in CBF using NIRS and those measured by TCD.…”

How to perform and interpret a middle cerebral artery transcranial Doppler examination in children at risk of brain injury

“…The relatively lower thickness of the skull around pterion, and the temporal bones adjacent to the ears—the temporal window—lets the ultrasound beam through and allows visualisation of the anatomy near circle of Willis 5 6. While many of the intracranial arteries can be studied, this article will focus on the MCA, because its size, position, direction of blood flow and significance make it the ideal candidate vessel to be insonated.…”

“…The ultrasound probe is placed so the beam is directed towards the opposite ear, whereas the probe marker faces anteriorly. Adapted from Caballero-Lozada et al 6 MCA, middle cerebral artery.…”

“…TCD data acquisition is subjected to some degree of operator-dependent interobserver variability 4–6. Widespread knowledge of or significant experience in this technique cannot be expected at the moment, as neuroapplications (including TCD ultrasound) are yet to make their way into the majority of formally accredited POCUS courses.…”

Transcranial Doppler: A Beginning of a New Era for Stroke Diagnosis

“…It can detect most lesions requiring interventional therapy, such as angioplasty, stenting, and local thrombolysis [3]. It can assess the cerebral hemodynamic consequences of steno-occlusive lesions in the cervical parent artery and monitor Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), and Midline Deviation allowing us to assess the patient's neurocritical pathological characteristics in a non-invasive manner [4].…”