Monitoring of Increased Intracranial Pressure Resulting From Cerebral Edema With Transcranial Doppler Sonography in Patients With Middle Cerebral Artery Infarction

Abstract

Transcranial Doppler sonography enables noninvasive monitoring of raised intracranial pressure in patients with large infarctions. It also provides information for detecting cerebral herniation and deciding on the medical or surgical therapy.

Prospective Study on Noninvasive Assessment of Intracranial Pressure in Traumatic Brain-Injured Patients: Comparison of Four Methods

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28] In these methods, the insonated compliant middle cerebral artery (MCA) is interpreted as a ''biological'' pressure transducer, with walls that can be deflected by transmural pressure (equivalent to cerebral perfusion pressure [CPP]), modulating accordingly the pulsatile waveform of cerebral blood flow velocity (FV). Transmission of this ''transducer,'' its linearity, stability in time, and calibration coefficients are unknownand these factors mainly contribute to limited accuracy of TCDbased methods.…”

Novel parameter for the diagnosis of distal middle cerebral artery stenosis with transcranial Doppler sonography

“…The MCA and its branches are the most commonly affected brain vessels in cerebral infarction. [15][16][17][22][23][24] Among MCA infarcts, the superficial MCA territory was involved in more than half of the patients, the deep MCA territory in one third, and the deep plus superficial MCA territory in one tenth. [26][27][28][29][30][31][32][33] Superficial MCA territory infarcts can be large when the occlusion of the MCA trunk involves its proximal segment at the level of the bifurcation or trifurcation just after the origin of the lenticulostriate arteries mainly because there is no efficient collateral system.…”

“…31,32 Moreover, when too much obscuring artifacts on MRA hamper the diagnosis of M2 stenosis, [1][2][3][4] TCD data may provide supportive information from which physicians can infer a stroke mechanism and plan for treatment. 22,23 In the majority of previous studies, velocity-based diagnostic criteria were chosen for the TCD diagnosis of intracranial stenosis. [1][2][3][4] TCD studies of MCA stenosis have been frequently reported.…”

Non-invasive Monitoring of Intracranial Pressure Using Transcranial Doppler Ultrasonography: Is It Possible?

“…Elevated PI (≥1.56) was predictive of poor outcomeRainov et al [51]Investigate a possible relationship between PI, RI, FV and ICP changes in adult patients with hydrocephalus29, HydrocephalusEpiduralPI in patients with elevated ICP prior to shunting was significantly increased. Preshunting ICP and PI were not correlated ( R  = 0.37)Asil et al [58]TCD was compared with clinical examination and neuroradiologic findings18, Stroke and MCA infarctionNMIncreases in PI were correlated with midline shift as indication of elevated ICP ( R  = 0.66*)Bellner et al [7]Investigate the relationship between ICP and PI in neurosurgical patients81, (SAH, TBI and other intracranial disorders)IntraventricularCorrelation between PI and ICP was R  = 0.94* (ICP = 10.93 × PI − 1.28)In the ICP range of 5–40 mmHg, the correlation formula is: ICP = 11.5 × PI − 2.23 ( R 2  = 0.73*)In this interval, SD for nICP_PI was ±2.5 mmHg in the ICP range of 5-40 mmHg95 % CI of ±4.2 mmHg88 (threshold of 10 mmHg)83 (threshold of 20 mmHg)69 (threshold of 10 mmHg)99 (threshold of 20 mmHg)Voulgaris et al [59]Investigate TCD as tool for detection of cerebral haemodynamics changes.37, TBIIntraparenchymalOverall correlation between ICP and PI was R  = 0.64*For ICP ≥ 20 mmHg, correlation was R  = 0.82*PI allows early identification of patients with low CPP and risk of cerebral ischemiaBehrens et al [49]Validate TCD as a method for ICP determination INPH10, INPHIntraparenchymalCorrelation between PI and ICP was R 2  = 0.22* (ICP = 23 × PI + 14)95 % CI for a mean ICP of 20 mmHg was −3.8 to 43.8 mmHgPI is not a reliable predictor of ICP<...>…”