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Yang R, Eagles ME. Methods of Monitoring Intracranial Pressure: A Review. Neurosurg Clin N Am 2025; 36:141-147. [PMID: 40054968 DOI: 10.1016/j.nec.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
Monitoring intracranial pressure (ICP) is important in a variety of neurologic conditions, including aneurysmal subarachnoid hemorrhage and traumatic brain injury. Monitoring and controlling ICP can mitigate secondary injury of the brain. Of the invasive methods of monitoring ICP, the external ventricular drain is still considered the gold standard. However, microtransducers have been shown to be a reliable option with significantly lower risks of complications. Due to their reproducibility, and their limitations, they are not ready to replace invasive ICP monitoring techniques. This article reviews the commonly used invasive and non-invasive methods of monitoring ICP.
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Affiliation(s)
- Runze Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Matthew E Eagles
- Department of Neurosurgery, University of Illinois Chicago, Chicago, IL, USA.
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Jordan J, O’Brien N, Li P, Musungufu DA, Ekandji RT, Mbaka JP, Mayindombe L, Giresse B, Phiri T, June S, Gushu Co MB, Tshimanga T, Reuter-Rice K. Variability of day-to-day pulsatility index change in children with cerebral malaria. Front Neurol 2024; 15:1466941. [PMID: 39588232 PMCID: PMC11586388 DOI: 10.3389/fneur.2024.1466941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 10/21/2024] [Indexed: 11/27/2024] Open
Abstract
Introduction Cerebral malaria (CM) is a devastating disease and better understanding of etiologies of the resulting neurologic injury is needed. The purpose of this study is to describe the day-to-day (DTD) pulsatility index (PI) change measured by transcranial Doppler ultrasound (TCD), a novel measure of cerebral and vascular changes, in children with CM. Methods A retrospective analysis of 122 children in sub-Saharan Africa with CM and 3 or more sequential TCD measurements was performed. Variability of DTD PI change was calculated as a measure of changes in vasculature overtime. Neurologic outcome was determined by the Pediatric Cerebral Performance Category (PCPC) score, a measure of neurologic function. Results Of the 122 participants, 77.9% had a good neurologic outcome (no neurologic sequelae), and 22.1% had a poor outcome (neurologic sequelae or died). Patients who had a poor neurologic outcome had higher levels of variability of DTD PI change in the right middle cerebral artery (MCA) (0.14 ± 0.21) and left MCA (0.17 ± 0.41) compared to those who had a good neurologic outcome (0.1 ± 0.1 and 0.11 ± 0.19, respectively). A higher variability of both left and right MCA DTD PI change was also associated with higher brain volume assessed through neuroimaging. Discussion Variability of DTD PI change may provide early prognostic information regarding PCPC outcomes and brain volume changes seen in CM patients. Expanded research on pathophysiologic contributors to variability of DTD PI changes in children with CM is warranted.
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Affiliation(s)
- Jeremy Jordan
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, United States
- Children’s of Alabama, Pediatric Critical Care, Birmingham, AL, United States
| | - Nicole O’Brien
- Nationwide Children’s Hospital, Columbus, OH, United States
| | - Peng Li
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, United States
| | | | - Robert Tandjeka Ekandji
- Universite des Sciences et des Technologie de Lodja (USTL), L’Hopital General de Reference de Lodja, Lodja, Democratic Republic of Congo
| | - Jean Pongo Mbaka
- Universite des Sciences et des Technologie de Lodja (USTL), L’Hopital General de Reference de Lodja, Lodja, Democratic Republic of Congo
| | - Ludovic Mayindombe
- Cliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De Kinshasa, Kimwenza, Democratic Republic of Congo
| | - Buba Giresse
- Cliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De Kinshasa, Kimwenza, Democratic Republic of Congo
| | | | | | | | - Taty Tshimanga
- Cliniques Universitaires de Kinshasa, Hopital Pediatrique de Kalembe Lembe, Universite De Kinshasa, Kimwenza, Democratic Republic of Congo
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Charles JH, Desai S, Jean Paul A, Hassan A. Multimodal imaging approach for the diagnosis of intracranial atherosclerotic disease (ICAD): Basic principles, current and future perspectives. Interv Neuroradiol 2024; 30:105-119. [PMID: 36262087 PMCID: PMC10956456 DOI: 10.1177/15910199221133170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD. METHODS A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included, "imaging modalities in ICAD," "ICAD diagnostic," "Neuroimaging of ICAD," "Evaluation of ICAD". A summary and comparison of each modality's basic principles, advantages and disadvantages were included. RESULTS A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD. CONCLUSIONS ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario, a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
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Affiliation(s)
| | - Sohum Desai
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Axler Jean Paul
- School of Medicine, State University of Haiti, Port Au Prince, Haiti
| | - Ameer Hassan
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
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Bidkar PU, Kannabiran N, Chatterjee P. Clinical applications of ultrasound in neurosurgery and neurocritical care: A narrative review. Med J Armed Forces India 2024; 80:16-28. [PMID: 38239602 PMCID: PMC10793236 DOI: 10.1016/j.mjafi.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/17/2023] [Indexed: 01/22/2024] Open
Abstract
Ultrasonography (USG) has become an invaluable tool in the assessment of neurocritical patients in the operating theaters and critical care units. Due to its easy availability, reliability, safety, and repeatability, neuro-intensivists and neuro-anesthesiologists utilize USG to make a diagnosis, assess prognosis, and decide upon treatment. In neurocritical care units, USG has myriad indications for use, both systemic and neurologic. The neurological indications include the assessment of stroke, vasospasm, traumatic brain injury, brain death, acute brain damage, optic nerve sheath diameter, and pupillary reflexes to name a few. The systemic indications range from assessment of cardio-pulmonary function and intravascular volume status to detection of deep venous thromboses, vocal cord assessment in intubated patients, placement of central venous catheters, and percutaneous tracheostomy. In this narrative review, we iterate the clinical applications of USG in neuroanesthesia and neurocritical care, which we penned after searching relevant databases in PubMed, Medline, Ovid, and Google Scholar by using terms such as ‘applications of transcranial Doppler’, ‘optic nerve sheath diameter’, ‘USG applications in the critical care unit’, and so on. Our search database includes several research papers, neurocritical care books, review articles, and scientific databases. This article reviews various applications of USG in neuroanesthesia, neurosurgery, and neurocritical care.
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Affiliation(s)
- Prasanna Udupi Bidkar
- Professor & Unit Head (Neuroanesthesiology), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | | | - Protiti Chatterjee
- Resident (Anesthesiology & Critical Care), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
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Manga S, Muthavarapu N, Redij R, Baraskar B, Kaur A, Gaddam S, Gopalakrishnan K, Shinde R, Rajagopal A, Samaddar P, Damani DN, Shivaram S, Dey S, Mitra D, Roy S, Kulkarni K, Arunachalam SP. Estimation of Physiologic Pressures: Invasive and Non-Invasive Techniques, AI Models, and Future Perspectives. SENSORS (BASEL, SWITZERLAND) 2023; 23:5744. [PMID: 37420919 DOI: 10.3390/s23125744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/25/2023] [Accepted: 06/12/2023] [Indexed: 07/09/2023]
Abstract
The measurement of physiologic pressure helps diagnose and prevent associated health complications. From typical conventional methods to more complicated modalities, such as the estimation of intracranial pressures, numerous invasive and noninvasive tools that provide us with insight into daily physiology and aid in understanding pathology are within our grasp. Currently, our standards for estimating vital pressures, including continuous BP measurements, pulmonary capillary wedge pressures, and hepatic portal gradients, involve the use of invasive modalities. As an emerging field in medical technology, artificial intelligence (AI) has been incorporated into analyzing and predicting patterns of physiologic pressures. AI has been used to construct models that have clinical applicability both in hospital settings and at-home settings for ease of use for patients. Studies applying AI to each of these compartmental pressures were searched and shortlisted for thorough assessment and review. There are several AI-based innovations in noninvasive blood pressure estimation based on imaging, auscultation, oscillometry and wearable technology employing biosignals. The purpose of this review is to provide an in-depth assessment of the involved physiologies, prevailing methodologies and emerging technologies incorporating AI in clinical practice for each type of compartmental pressure measurement. We also bring to the forefront AI-based noninvasive estimation techniques for physiologic pressure based on microwave systems that have promising potential for clinical practice.
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Affiliation(s)
- Sharanya Manga
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Neha Muthavarapu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Renisha Redij
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Avneet Kaur
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Sunil Gaddam
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Keerthy Gopalakrishnan
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Rutuja Shinde
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Poulami Samaddar
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Devanshi N Damani
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX 79995, USA
| | - Suganti Shivaram
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Shuvashis Dey
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical and Computer Engineering, North Dakota State University, Fargo, ND 58105, USA
| | - Dipankar Mitra
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Computer Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Sayan Roy
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Electrical Engineering and Computer Science, South Dakota Mines, Rapid City, SD 57701, USA
| | - Kanchan Kulkarni
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, U1045, 33000 Bordeaux, France
- IHU Liryc, Heart Rhythm Disease Institute, Fondation Bordeaux Université, Bordeaux, 33600 Pessac, France
| | - Shivaram P Arunachalam
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Vitt JR, Loper NE, Mainali S. Multimodal and autoregulation monitoring in the neurointensive care unit. Front Neurol 2023; 14:1155986. [PMID: 37153655 PMCID: PMC10157267 DOI: 10.3389/fneur.2023.1155986] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
Given the complexity of cerebral pathology in patients with acute brain injury, various neuromonitoring strategies have been developed to better appreciate physiologic relationships and potentially harmful derangements. There is ample evidence that bundling several neuromonitoring devices, termed "multimodal monitoring," is more beneficial compared to monitoring individual parameters as each may capture different and complementary aspects of cerebral physiology to provide a comprehensive picture that can help guide management. Furthermore, each modality has specific strengths and limitations that depend largely on spatiotemporal characteristics and complexity of the signal acquired. In this review we focus on the common clinical neuromonitoring techniques including intracranial pressure, brain tissue oxygenation, transcranial doppler and near-infrared spectroscopy with a focus on how each modality can also provide useful information about cerebral autoregulation capacity. Finally, we discuss the current evidence in using these modalities to support clinical decision making as well as potential insights into the future of advanced cerebral homeostatic assessments including neurovascular coupling.
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Affiliation(s)
- Jeffrey R. Vitt
- Department of Neurological Surgery, UC Davis Medical Center, Sacramento, CA, United States
- Department of Neurology, UC Davis Medical Center, Sacramento, CA, United States
| | - Nicholas E. Loper
- Department of Neurological Surgery, UC Davis Medical Center, Sacramento, CA, United States
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
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Yu H, Ande SR, Batoo D, Linton J, Shankar J. Prognostic Value of Initial Diagnostic Imaging Findings for Patient Outcomes in Adult Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Tomography 2023; 9:509-528. [PMID: 36961001 PMCID: PMC10037627 DOI: 10.3390/tomography9020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Termed the "silent epidemic," traumatic brain injury (TBI) is one of the greatest global contributors not only to post-traumatic death but also to post-traumatic long-term disability. This systematic review and meta-analysis aims to specifically evaluate the prognostic value of features on initial imaging completed within 24 h of arrival in adult patients with TBI. METHOD The authors followed the PRISMA 2020 checklist for systematic review and meta-analysis design and reporting. Comprehensive searches of the Medline and Embase databases were carried out. Two independent readers extracted the following demographic, clinical and imaging information using a predetermined data abstraction form. Statistics were performed using Revman 5.4.1 and R version 4.2.0. For pooled data in meta-analysis, forest plots for sensitivity and specificity were created to calculate the diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) curves were generated using a bivariate model, and diagnostic accuracy was determined using pooled sensitivity and specificity as well as the area under the receiver operator characteristic curve (AUC). RESULTS There were 10,733 patients over the 19 studies. Overall, most of the studies included had high levels of bias in multiple, particularly when it came to selection bias in patient sampling, bias in controlling for confounders, and reporting bias, such as in reporting missing data. Only subdural hematoma (SDH) and mortality in all TBI patients had both an AUC with 95% CI not crossing 0.5 and a DOR with 95% CI not crossing 1, at 0.593 (95% CI: 0.556-0.725) and 2.755 (95% CI: 1.474-5.148), respectively. CONCLUSION In meta-analysis, only SDH with mortality in all TBI patients had a moderate but significant association. Given the small number of studies, additional research focused on initial imaging, particularly for imaging modalities other than NECT, is required in order to confirm the findings of our meta-analysis and to further evaluate the association of imaging findings and outcome.
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Affiliation(s)
- Hang Yu
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Sudharsana Rao Ande
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Divjeet Batoo
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Janice Linton
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Jai Shankar
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
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Dattilo M. Noninvasive methods to monitor intracranial pressure. Curr Opin Neurol 2023; 36:1-9. [PMID: 36630209 DOI: 10.1097/wco.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Intracranial pressure (ICP) is determined by the production of and outflow facility of cerebrospinal fluid. Since alterations in ICP are implicated in several vision-threatening and life-threatening diseases, measurement of ICP is necessary and common. All current clinical methods to measure ICP are invasive and carry the risk for significant side effects. Therefore, the development of accurate, reliable, objective, and portal noninvasive devices to measure ICP has the potential to change the practice of medicine. This review discusses recent advances and barriers to the clinical implementation of noninvasive devices to determine ICP. RECENT FINDINGS Many noninvasive methods to determine ICP have been developed. Although most have significant limitations limiting their clinical utility, several noninvasive methods have shown strong correlations with invasively obtained ICP and have excellent potential to be developed further to accurately quantify ICP and ICP changes. SUMMARY Although invasive methods remain the mainstay for ICP determination and monitoring, several noninvasive biomarkers have shown promise to quantitatively assess and monitor ICP. With further refinement and advancement of these techniques, it is highly possible that noninvasive methods will become more commonplace and may complement or even supplant invasively obtained methods to determine ICP in certain situations.
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Affiliation(s)
- Michael Dattilo
- Emory Eye Center, Neuro-Ophthalmology Division, Emory University School of Medicine, Atlanta, Georgia, USA
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Liang Y, Duan Y, Xing C, Jin J, Yan L, Liu X, Wang J. Clinical Value of TCCD for Evaluating the Prognosis of Patients with Severe Traumatic Brain Injury After Large Decompressive Craniectomy: A Retrospective Study. Adv Ther 2022; 39:4556-4567. [PMID: 35934765 DOI: 10.1007/s12325-022-02251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/29/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION It is challenging to assess the prognosis of patients with severe traumatic brain injury (sTBI) after large decompressive craniectomy (DC). The aim of this study was to evaluate the clinical value of transcranial color-coded duplex sonography (TCCD) for assessing the prognosis of sTBI patients 6 months after large DC. METHODS This was a retrospective observational study that consecutively enrolled 84 patients with sTBI who were followed up for prognosis until 6 months after large DC. The primary endpoint was the Glasgow Outcome Score (GOS). According to the GOS, patients were divided into an unfavorable prognosis group (GOS 1-3, n = 47) and a favorable prognosis group (GOS 4-5, n = 37). RESULTS Significant between-group differences were found in age and hemodynamic parameters (systolic peak blood flow velocity, end-diastolic blood flow velocity, mean blood flow velocity, pulsatility index and resistance index) of the middle cerebral artery detected by TCCD (P < 0.05 for all). Subsequently, ridge regression was used to build a prognostic model for patients with large DC. Based on the cerebral hemodynamic parameters measured by TCCD and age, the mean (± standard deviation) area under the curve of the prognostic model in patients with sTBI after large DC was 0.76 ± 0.22. The sensitivity and specificity were 82.08% and 74.17%, respectively. CONCLUSIONS The cerebral hemodynamic parameters detected by TCCD, combined with age, may be used to predict the outcomes of patients with sTBI at 6 months after large DC. As a noninvasive method, TCCD has the potential to assess the prognosis of these patients. TRIAL REGISTRATION ChiCTR: ChiCTR1800019758. Registered 27 November 2018-retrospectively registered ( http://www.chictr.org.cn/index.aspx ).
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Affiliation(s)
- Yuan Liang
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Yunyou Duan
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Changyang Xing
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jinglan Jin
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Lingjuan Yan
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Xi Liu
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jia Wang
- Department of Ultrasound Diagnosis, Tangdu Hospital, Air Force Medical University, Xi'an, China.
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Dzierzęcki S, Ząbek M, Zapolska G, Tomasiuk R. The S-100B level, intracranial pressure, body temperature, and transcranial blood flow velocities predict the outcome of the treatment of severe brain injury. Medicine (Baltimore) 2022; 101:e30348. [PMID: 36197246 PMCID: PMC9509168 DOI: 10.1097/md.0000000000030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study evaluates the applicability of S100B levels, mean maximum velocity (Vmean) over time, pulsatility index (PI), intracranial pressure (ICP), and body temperature (T) for the prediction of the treatment of patients with traumatic brain injury (TBI). Sixty patients defined by the Glasgow Coma Scale score ≤ 8 were stratified using the Glasgow Coma Scale into 2 groups: favorable (FG: Glasgow Outcome Scale ≥ 4) and unfavorable (UG: Glasgow Outcome Scale < 4). The S100B concentration was at the time of hospital admission. Vmean was measured using transcranial Doppler. PI was derived from a transcranial Doppler examination. T was measured in the temporal artery. The differences in mean between FG and UG were tested using a bootstrap test of 10,000 repetitions with replacement. Changes in S100B, Vmean, PI, ICP, and T levels stratified by the group were calculated using the one-way aligned rank transform for nonparametric factorial analysis of variance. The reference ranges for the levels of S100B, Vmean, and PI were 0.05 to 0.23 µg/L, 30.8 to 73.17 cm/s, and 0.62 to 1.13, respectively. Both groups were defined by an increase in Vmean, a decrease in S100B, PI, and ICP levels; and a virtually constant T. The unfavorable outcome is defined by significantly higher levels of all parameters, except T. A favorable outcome is defined by S100B < 3 mg/L, PI < 2.86, ICP > 25 mm Hg, and Vmean > 40 cm/s. The relationships provided may serve as indicators of the results of the TBI treatment.
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Affiliation(s)
- Sebastian Dzierzęcki
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Gamma Knife Centre, Brodno Masovian Hospital, Warsaw, Poland
- *Correspondence: Sebastian Dzierzecki, Warsaw Gamma Knife Centre, Brodno Masovian Hospital, Kondratowicza 8 Building H, 03-242 Warsaw, Poland (e-mail: )
| | - Mirosław Ząbek
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Clinical Department of Neurosurgery, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | | | - Ryszard Tomasiuk
- Kazimierz Pulaski University of Technology and Humanities Radom, Faculty of Medical Sciences and Health Sciences, Radom, Poland
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Shono Y, Mezuki S, Akahoshi T, Nishihara M, Kaku N, Maki J, Tokuda K, Kitazono T. Prediction of intracranial lesions in patients with consciousness disturbance by ultrasonography in the intensive care unit. J Int Med Res 2022; 50:3000605221119358. [PMID: 36124942 PMCID: PMC9500273 DOI: 10.1177/03000605221119358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to evaluate the correlation between parameters
measured by bedside ultrasonography and detection of intracranial organic
lesions in patients with impaired consciousness in an intensive care unit
(ICU) setting. Methods We retrospectively reviewed the medical records of patients who were admitted
to our ICU from April 2017 to July 2019. Patients who underwent computed
tomography or magnetic resonance imaging examination and measurement of the
flow velocity of the carotid and intracranial arteries and the optic nerve
sheath diameter by ultrasonography were selected for analysis. Results In total, 64 patients were analyzed in this study. Of these, intracranial
lesions were detected by computed tomography or magnetic resonance imaging
in 17 (27%) patients. The left:right ratio of the end-diastolic velocity of
the bilateral common carotid artery (CCA-ED ratio) and the pulsatility index
of the middle cerebral artery (MCA-PI) were significantly higher in patients
with than in those without intracranial lesions. The cut-off value of the
CCA-ED ratio was 1.55 (sensitivity, 66.7%; specificity, 81.6%), and that of
the MCA-PI was 1.21 (sensitivity, 57.1%; specificity, 76.7%). Conclusion Bedside ultrasonography is useful for predicting intracranial lesions
requiring therapeutic intervention in ICU patients with impaired
consciousness.
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Affiliation(s)
- Yuji Shono
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Satomi Mezuki
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tomohiko Akahoshi
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaaki Nishihara
- Emergency and Critical Care Center, Kyushu University Hospital, Japan
| | - Noriyuki Kaku
- Emergency and Critical Care Center, Kyushu University Hospital, Japan
| | - Jun Maki
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Kentaro Tokuda
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Takanari Kitazono
- Emergency and Critical Care Center, Kyushu University Hospital, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
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Jordan J, Ladores S, Kong M, Smith T, Li P, Reuter-Rice K. Association between Day-to-Day Pulsatility Index Change and Neurocognitive Outcomes in Pediatric Traumatic Brain Injury. Neurotrauma Rep 2022; 3:369-376. [PMID: 36204387 PMCID: PMC9531876 DOI: 10.1089/neur.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality in children despite advances in prevention and mitigation strategies. Transcranial Doppler (TCD) ultrasound measures cerebral arterial circulation and allows for the calculation of pulsatility indices (PIs), which provides an assessment of cerebral blood flow changes. Yet, the use of PIs in children with TBI is not well understood. In this study, we defined the day-to-day (DTD) PI change of the anterior cerebral circulation and describe its relationship with injury characteristics and neurocognitive outcomes in children with TBI. A prospective observational parent study of 42 children, 2 months to 15 years of age, with mild or moderate-severe TBI who had serial TCDs provided data for this analysis. Both the mean and variation of DTD PI change were evaluated in the context of injury severity, injury sidedness, and neurocognitive outcome. In those with a unilateral injury, a larger mean DTD PI change in both the injured and uninjured side was found in those with a worse Glasgow Outcome Scale-Extended Pediatrics score at discharge. A larger variation in PI was associated with a worse neurocognitive outcome, irrespective of injury severity. Therefore, the mean and variation of DTD PI change may serve as a potential cerebral vascular biomarker of ongoing secondary injury. The use of PI measurements in the monitoring of children with TBI may provide clinicians with new diagnostic and prognostic insights to inform therapeutic interventions and recovery strategies. However, a larger prospective study is needed to confirm these findings and elucidate potential mechanistic links between DTD PI and clinical outcome measures. To our knowledge, this study is the first of its kind to evaluate the use of PI changes in cerebral vasculature in pediatric TBI patients admitted to the hospital.
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Affiliation(s)
- Jeremy Jordan
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Pediatric Critical Care Medicine, Children's of Alabama, Birmingham, Alabama, USA
| | - Sigrid Ladores
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michele Kong
- Pediatric Critical Care Medicine, Children's of Alabama, Birmingham, Alabama, USA
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tedra Smith
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peng Li
- School of Nursing, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lehrer H, Dayan I, Elkayam K, Kfir A, Bierman U, Front L, Catz A, Aidinoff E. Responses to stimuli in the 'snoezelen' room in unresponsive wakefulness or in minimally responsive state. Brain Inj 2022; 36:1167-1175. [PMID: 35978560 DOI: 10.1080/02699052.2022.2110286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sensory stimulation in Snoezelen room increased responsiveness after brain injury and dementia. OBJECTIVE To explore the physiological and clinical effects of Snoezelen stimulation in persons with unresponsive wakefulness syndrome or minimally conscious state (UWS or MCS). DESIGN A comparative prospective observational cohort study. METHODS Ten patients with UWS and 25 in MCS were exposed to consecutive stimuli involving the 5 senses in a Snoezelen room. Heart rate (HR) and cerebral blood flow velocity (CBFV), and scores of the Loewenstein communication scale (LCS) were obtained before and during or after the stimuli. RESULTS The stimuli increased HR values and decreased left hemisphere CBFV values in patients with MCS (p < 0.05). Stimulation increased LCS scores (from 28.48 ± 6.55 to 31.13 ± 7.14; p < 0.001) in patients with MCS, but not in the UWS group. LCS gain correlated with HR and right hemisphere CBFV gains in patients with MCS (r = 0.439 and 0.636 respectively, p < 0.05). CONCLUSIONS Snoezelen stimulation induced immediate improvement in communication and physiological changes in patients with MSC, and had a minor physiological effect in patients with UWS. If additional studies support these findings, it will be possible to suggest that Snoezelen stimulation can affect arousal, and possibly improve functioning.
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Affiliation(s)
- Hiela Lehrer
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Ilil Dayan
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Keren Elkayam
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Adi Kfir
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Uri Bierman
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Lilach Front
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Amiram Catz
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel.,Sackler Faculty of Medicine, Rehabilitation Department, Tel Aviv University, Tel Aviv, Israel
| | - Elena Aidinoff
- Departments of Intensive Care for Consciousness Rehabilitation and Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel.,Sackler Faculty of Medicine, Rehabilitation Department, Tel Aviv University, Tel Aviv, Israel
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14
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Stem CT, Ramgopal S, Hickey RW, Manole MD, Balzer JR. Effect of ketamine on transcranial Doppler Gosling pulsatility index in children undergoing procedural sedation: A pilot study. J Am Coll Emerg Physicians Open 2022; 3:e12760. [PMID: 35865130 PMCID: PMC9292470 DOI: 10.1002/emp2.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives There has been controversy over whether ketamine affects intracranial pressure (ICP) in children. Transcranial Doppler ultrasound (TCD) is a validated technique used to assess ICP changes noninvasively. Gosling pulsatility index (PI) directly correlates with ICP changes. The objective of this study was to quantify PI changes as a surrogate marker for ICP changes in previously healthy children receiving intravenous ketamine for procedural sedation. Methods We performed a prospective, observational study of patients 5-18 years old who underwent sedation with intravenous ketamine as monotherapy. ICP changes were assessed by surrogate PI at baseline, immediately after ketamine administration, and every 5 minutes until completion of the procedure. The primary outcome measure was PI change after ketamine administration compared to baseline (denoted ΔPI). Results We enrolled 15 participants. Mean age was 9.9 ± 3.4 years. Most participants underwent sedation for fracture reduction (87%). Mean initial ketamine dose was 1.4 ± 0.3 mg/kg. PI decreased at all time points after ketamine administration. Mean ΔPI at sedation onset was -0.23 (95% confidence interval [CI] = -0.30 to -0.15), at 5 minutes was -0.23 (95% CI = -0.28 to -0.18), at 10 minutes was -0.14 (95% CI = -0.21 to -0.08), at 15 minutes was -0.18 (95% CI = -0.25 to -0.12), and at 20 minutes was -0.19 (95% CI = -0.26 to -0.12). Using a clinically relevant threshold of ΔPI set at +1 (+8 cm H2O), no elevation in ICP, based on the PI surrogate marker, was demonstrated with 95% confidence at all time points after ketamine administration. Conclusions Ketamine did not significantly increase PI, which was used as a surrogate marker for ICP in this sample of previously healthy children. This pilot study demonstrates a model for evaluating ICP changes noninvasively in the emergency department.
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Affiliation(s)
- Christopher T. Stem
- Division of Pediatric Emergency MedicineDepartment of PediatricsMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Division of Emergency MedicineDepartment of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Sriram Ramgopal
- Division of Emergency MedicineDepartment of PediatricsAnn & Robert H. Lurie Children's Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Robert W. Hickey
- Division of Emergency MedicineDepartment of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Mioara D. Manole
- Division of Emergency MedicineDepartment of PediatricsUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Jeffrey R. Balzer
- Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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15
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Pan J, Wu H, Wu T, Geng Y, Yuan R. Association Between Post-procedure Cerebral Blood Flow Velocity and Severity of Brain Edema in Acute Ischemic Stroke With Early Endovascular Therapy. Front Neurol 2022; 13:906377. [PMID: 35923831 PMCID: PMC9339960 DOI: 10.3389/fneur.2022.906377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWe aimed to investigate the association between post-procedure cerebral blood flow velocity (CBFV) and severity of brain edema in patients with acute ischemic stroke (AIS) who received early endovascular therapy (EVT).MethodsWe retrospectively included patients with AIS who received EVT within 24 h of onset between February 2016 and November 2021. Post-procedure CBFV of the middle cerebral artery was measured in the affected and the contralateral hemispheres using transcranial Doppler ultrasound. The severity of brain edema was measured using the three-level cerebral edema grading from the Safe Implementation of Thrombolysis in Stroke-Monitoring Study, with grades 2–3 indicating severe brain edema. The Association between CBFV parameters and severity of brain edema was analyzed.ResultsA total of 101 patients (mean age 64.2 years, 65.3% male) were included, of whom 56.3% (57/101) suffered brain edema [grade 1, 23 (22.8%); grade 2, 10 (9.9%); and grade 3, 24 (23.8%)]. Compared to patients with non-severe brain edema, patients with severe brain edema had lower affected/contralateral ratios of systolic CBFV (median 1 vs. 1.2, P = 0.020) and mean CBFV (median 0.9 vs. 1.3, P = 0.029). Multivariate logistic regression showed that severe brain edema was independently associated with affected/contralateral ratios of systolic CBFV [odds ratio (OR) = 0.289, 95% confidence interval (CI): 0.069–0.861, P = 0.028] and mean CBFV (OR = 0.278, 95% CI: 0.084–0.914, P = 0.035) after adjusting for potential confounders.ConclusionPost-procedure affected/contralateral ratio of CBFV may be a promising predictor of brain edema severity in patients with AIS who received early EVT.
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Affiliation(s)
- Jie Pan
- Suzhou Medical College of Soochow University, Suzhou, China
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Huadong Wu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Tingting Wu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yu Geng
- Suzhou Medical College of Soochow University, Suzhou, China
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Ruozhen Yuan
| | - Ruozhen Yuan
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- Yu Geng
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16
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Cerebral Pulsatility Index and In-Hospital Mortality in Chinese Patients with Traumatic Brain Injury: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11061559. [PMID: 35329885 PMCID: PMC8950001 DOI: 10.3390/jcm11061559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
There are limited studies on the relationship between the vascular transcranial Doppler (TCD) pulsatility index (PI) and in-hospital mortality in patients with traumatic brain injury (TBI). To address this issue, we conducted this study to explore whether, in newly diagnosed Chinese TBI patients, the PI is an independent predictor of the in-hospital mortality rate after adjusting for other covariates. This study is a retrospective cohort study. From 24 March 2019 to 24 January 2020, we recruited 144 Chinese patients with newly diagnosed TBI from a Chinese hospital. The independent variable was the PI, and the dependent variable was in-hospital mortality in TBI patients. The relationship between the PI and in-hospital mortality in TBI patients was nonlinear and had an inflection point of 1.11. In the multivariate analysis, after adjusting for potential confounders, the effect sizes and confidence intervals per additional 0.1 units on the left and right sides of the inflection point were 4.09 (1.30–12.83) and 1.42 (0.93–2.17). The relationship between the PI and in-hospital mortality was nonlinear. The PI was positively related with in-hospital mortality when the PI was less than 1.11.
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17
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Pinillos OM, Rodríguez CN, Hakimi R. Transcranial Doppler Ultrasound Pulsatility Index: Utility and Clinical Interpretation. NEUROSONOLOGY IN CRITICAL CARE 2022:357-376. [DOI: 10.1007/978-3-030-81419-9_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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18
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Tomasiuk R, Dzierzęcki S, Zaczyński A, Ząbek M. Usability of the Level of the S100B Protein, the Gosling Pulsatility Index, and the Jugular Venous Oxygen Saturation for the Prediction of Mortality and Morbidity in Patients with Severe Traumatic Brain Injury. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2398488. [PMID: 34734081 PMCID: PMC8560266 DOI: 10.1155/2021/2398488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
The high frequency of traumatic brain injury imposes severe economic stress on health and insurance services. The objective of this study was to analyze the association between the serum S100B protein, the Gosling pulsatility index (PI), and the level of oxygen saturation at the tip of the internal jugular vein (SjVO2%) in patients diagnosed with severe TBI. The severity of TBI was assessed by a GCS score ≤ 8 stratified by Glasgow outcome scale (GOS) measured on the day of discharge from the hospital. Two groups were included: GOS < 4 (unfavorable group (UG)) and GOS ≥ 4 (favorable group (UG)). S100B levels were higher in the UG than in the FG. PI levels in the UG were also substantially higher than in the FG. There were similar levels of SjVO2 in the two groups. This study confirmed that serum S100B levels were higher in patients with unfavorable outcomes than in those with favorable outcomes. Moreover, a clear demarcation in PI between unfavorable and FGs was observed. This report shows that mortality and morbidity rates in patients with traumatic brain injury can be assessed within the first 4 days of hospitalization using the S100B protein, PI values, and SjVO2.
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Affiliation(s)
- Ryszard Tomasiuk
- Kazimierz Pulaski University of Technology and Humanities Radom, Faculty of Medical Sciences and Health Sciences, Radom, Poland
| | - Sebastian Dzierzęcki
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Gamma Knife Centre, Brodno Masovian Hospital, Warsaw, Poland
| | - Artur Zaczyński
- Clinical Department of Neurosurgery, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Mirosław Ząbek
- Department of Neurosurgery, Postgraduate Medical Centre, Warsaw, Poland
- Gamma Knife Centre, Brodno Masovian Hospital, Warsaw, Poland
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19
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Gomez A, Batson C, Froese L, Sainbhi AS, Zeiler FA. Utility of Transcranial Doppler in Moderate and Severe Traumatic Brain Injury: A Narrative Review of Cerebral Physiologic Metrics. J Neurotrauma 2021; 38:2206-2220. [PMID: 33554739 PMCID: PMC8328046 DOI: 10.1089/neu.2020.7523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Since its creation in the 1980s, transcranial Doppler (TCD) has provided a method of non-invasively monitoring cerebral physiology and has become an invaluable tool in neurocritical care. In this narrative review, we examine the role TCD has in the management of the moderate and severe traumatic brain injury (TBI) patient. We examine the principles of TCD and the ways in which it has been applied to gain insight into cerebral physiology following TBI, as well as explore the clinical evidence supporting these applications. Its usefulness as a tool to non-invasively determine intracranial pressure, detect post-traumatic vasospasm, predict patient outcome, and assess the state of cerebral autoregulation are all explored.
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Affiliation(s)
- Alwyn Gomez
- Department of Surgery, University of Manitoba, Winnipeg, Canada
- Department of Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
| | - Carleen Batson
- Department of Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
| | - Logan Froese
- Department of Biomedical Engineering, University of Manitoba, Winnipeg, Canada
| | | | - Frederick Adam Zeiler
- Department of Surgery, University of Manitoba, Winnipeg, Canada
- Department of Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
- Department of Biomedical Engineering, University of Manitoba, Winnipeg, Canada
- Center on Aging, University of Manitoba, Winnipeg, Canada
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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20
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Efficacy of Noninvasive Technologies in Triaging Traumatic Brain Injury and Correlating With Intracranial Pressure: A Prospective Study. J Surg Res 2021; 262:27-37. [PMID: 33540153 DOI: 10.1016/j.jss.2020.12.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is interest in methods of measuring noninvasive intracranial pressure (ICP), including pupillometry, ultrasonographic transcranial Doppler (TCD), and optic nerve sheath diameter (ONSD), for diagnosing traumatic brain injury (TBI) in limited resource environments. Whether these technologies have diagnostic agreement is unknown. We hypothesized that ONSD, pupillometry, and TCD could both distinguish severe TBI and correlate with ICP. METHODS A prospective study of 135 patients was conducted at a level 1 trauma center. Four test groups were established: nontrauma patients with ICP monitoring, trauma patients without TBI, trauma patients with mild TBI, and trauma patients with severe TBI with ICP monitoring. All patients underwent daily measurements of ONSD, pupillometry, and TCD with both CX50 Sonosite and the Spencer ST3 Yi Pencil probe. RESULTS ONSD differed significantly in patients with severe TBI compared with patients with mild and no TBI, but did not correlate with ICP. Pupillometric constriction velocity, dilation velocity, and percent change in pupil diameter were significantly different in patients with severe TBI, but also did not correlate with ICP. TCD did not differ among TBI severities, but middle cerebral artery peak systolic velocity, middle cerebral artery flow velocity, and carotid flow velocity correlated with ICP. CONCLUSIONS This is a novel study of four noninvasive tests to screen for severity of TBI and measure ICP. Our analysis indicates that no single device can do both. However, ONSD and pupillometry may be used as a supplementary screening tool for severe TBI, whereas TCD could be used to estimate and follow ICP in patients with severe TBI.
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21
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Rollet-Cohen V, Sachs P, Léger PL, Merchaoui Z, Rambaud J, Berteloot L, Kossorotoff M, Mortamet G, Dauger S, Tissieres P, Renolleau S, Oualha M. Transcranial Doppler Use in Non-traumatic Critically Ill Children: A Multicentre Descriptive Study. Front Pediatr 2021; 9:609175. [PMID: 34277513 PMCID: PMC8282928 DOI: 10.3389/fped.2021.609175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The use and perceived value of transcranial Doppler (TCD) scope in paediatric critical care medicine has not been extensively documented. Objective: To describe the use of TCD to assess non-traumatic brain injury in patients admitted to four paediatric intensive care units (PICUs) in France. Methods: We prospectively included all children (aged under 18) assessed with inpatient TCD between November 2014 and October 2015 at one of the four PICUs. The physicians completed a questionnaire within 4 h of performing TCD. Results: 152 children were included. The primary diagnosis was neurological disease in 106 patients (70%), including post ischemic-anoxic brain insult (n = 42, 28%), status epilepticus (n = 19, 13%), and central nervous system infection/inflammation (n = 15, 10%). TCD was the first-line neuromonitoring assessment in 110 patients (72%) and was performed within 24 h of admission in 112 patients (74%). The most common indications for TCD were the routine monitoring of neurological disorders (n = 85, 56%) and the detection of asymptomatic neurological disorders (n = 37, 24). Concordance between the operator's interpretation of TCD and the published normative values was observed for 21 of the 75 (28%) TCD abnormal findings according to the published normative values. The physicians considered that TCD was of value for the ongoing clinical management of 131 (86%) of the 152 patients. Conclusion: TCD is commonly used in French PICUs and tends to be performed early after admission on patients with a broad range of diseases. The physicians reported that the TCD findings often helped their clinical decision making. In view of the subjectivity of bedside interpretation, true TCD contribution to clinical care remains to be determined. Objective studies of the impact of TCD on patient management and clinical outcomes are therefore warranted.
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Affiliation(s)
- Virginie Rollet-Cohen
- Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Philippe Sachs
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Pierre-Louis Léger
- Paediatric and Neonatal Intensive Care Unit, Trousseau University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Zied Merchaoui
- Pediatric Intensive Care, Paris South University Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Jérôme Rambaud
- Paediatric and Neonatal Intensive Care Unit, Trousseau University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Laureline Berteloot
- Paediatric Radiology Department, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Manoëlle Kossorotoff
- Paediatric Neurology Department, French Centre for Paediatric Stroke, Necker-Enfants-Malades University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Guillaume Mortamet
- Paediatric Intensive Care Unit, Grenoble University Hospital, Grenoble, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Pierre Tissieres
- Pediatric Intensive Care, Paris South University Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Sylvain Renolleau
- Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Mehdi Oualha
- Paediatric Intensive Care Unit, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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22
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Whiting MD, Dengler BA, Rodriguez CL, Blodgett D, Cohen AB, Januszkiewicz AJ, Rasmussen TE, Brody DL. Prehospital Detection of Life-Threatening Intracranial Pathology: An Unmet Need for Severe TBI in Austere, Rural, and Remote Areas. Front Neurol 2020; 11:599268. [PMID: 33193067 PMCID: PMC7662094 DOI: 10.3389/fneur.2020.599268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022] Open
Abstract
Severe traumatic brain injury (TBI) is a leading cause of death and disability worldwide, especially in low- and middle-income countries, and in austere, rural, and remote settings. The purpose of this Perspective is to challenge the notion that accurate and actionable diagnosis of the most severe brain injuries should be limited to physicians and other highly-trained specialists located at hospitals. Further, we aim to demonstrate that the great opportunity to improve severe TBI care is in the prehospital setting. Here, we discuss potential applications of prehospital diagnostics, including ultrasound and near-infrared spectroscopy (NIRS) for detection of life-threatening subdural and epidural hemorrhage, as well as monitoring of cerebral hemodynamics following severe TBI. Ultrasound-based methods for assessment of cerebrovascular hemodynamics, vasospasm, and intracranial pressure have substantial promise, but have been mainly used in hospital settings; substantial development will be required for prehospital optimization. Compared to ultrasound, NIRS is better suited to assess certain aspects of intracranial pathology and has a smaller form factor. Thus, NIRS is potentially closer to becoming a reliable method for non-invasive intracranial assessment and cerebral monitoring in the prehospital setting. While one current continuous wave NIRS-based device has been FDA-approved for detection of subdural and epidural hemorrhage, NIRS methods using frequency domain technology have greater potential to improve diagnosis and monitoring in the prehospital setting. In addition to better technology, advances in large animal models, provider training, and implementation science represent opportunities to accelerate progress in prehospital care for severe TBI in austere, rural, and remote areas.
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Affiliation(s)
- Mark D Whiting
- The Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences and National Institutes of Health, Bethesda, MD, United States.,Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL, United States
| | - Bradley A Dengler
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Carissa L Rodriguez
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, United States
| | - David Blodgett
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, United States
| | - Adam B Cohen
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, United States.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Todd E Rasmussen
- The Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences and National Institutes of Health, Bethesda, MD, United States.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - David L Brody
- The Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences and National Institutes of Health, Bethesda, MD, United States.,Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
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23
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Canac N, Jalaleddini K, Thorpe SG, Thibeault CM, Hamilton RB. Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring. Fluids Barriers CNS 2020; 17:40. [PMID: 32576216 PMCID: PMC7310456 DOI: 10.1186/s12987-020-00201-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/11/2020] [Indexed: 12/30/2022] Open
Abstract
Measurement of intracranial pressure (ICP) is crucial in the management of many neurological conditions. However, due to the invasiveness, high cost, and required expertise of available ICP monitoring techniques, many patients who could benefit from ICP monitoring do not receive it. As a result, there has been a substantial effort to explore and develop novel noninvasive ICP monitoring techniques to improve the overall clinical care of patients who may be suffering from ICP disorders. This review attempts to summarize the general pathophysiology of ICP, discuss the importance and current state of ICP monitoring, and describe the many methods that have been proposed for noninvasive ICP monitoring. These noninvasive methods can be broken down into four major categories: fluid dynamic, otic, ophthalmic, and electrophysiologic. Each category is discussed in detail along with its associated techniques and their advantages, disadvantages, and reported accuracy. A particular emphasis in this review will be dedicated to methods based on the use of transcranial Doppler ultrasound. At present, it appears that the available noninvasive methods are either not sufficiently accurate, reliable, or robust enough for widespread clinical adoption or require additional independent validation. However, several methods appear promising and through additional study and clinical validation, could eventually make their way into clinical practice.
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Chen LM, Wang LJ, Shi L, Chen HX, Jiang XH, Chen QQ, Xing YQ. Reliability of Assessing Non-severe Elevation of Intracranial Pressure Using Optic Nerve Sheath Diameter and Transcranial Doppler Parameters. Front Neurol 2019; 10:1091. [PMID: 31695668 PMCID: PMC6817673 DOI: 10.3389/fneur.2019.01091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background/Aims: Non-invasive measurement of intracranial pressure (ICP) using ultrasound has garnered increasing attention. This study aimed to compare the reliability of ultrasonographic measurement of optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD) in detecting potential ICP elevations. Methods: Patients who needed lumbar puncture (LP) in the Department of Neurology were recruited from December 2016 to July 2017. The ONSD and TCD measurements were completed before LP. Results: One hundred sixty-five participants (mean age, 41.96 ± 14.64 years; 80 men; 29 patients with elevated ICP) were included in this study. The mean ICP was 170 ± 52 mmH2O (range, 75-400 mmH2O). Univariate analyses revealed that ICP was non-significantly associated with TCD parameters and significantly associated with ONSD (r = 0.60, P < 0.001). The mean ONSD of the elevated ICP group was significantly higher than that of the normal ICP group (4.53 ± 0.40 mm vs. 3.97 ± 0.23 mm; P < 0.001). Multivariate linear regression determined that the difference between ICP and ONSD is significant. Conclusions: In the early stage of intracranial hypertension, ONSD is more reliable for evaluating ICP than TCD.
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Affiliation(s)
- Li-Min Chen
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Wang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Lin Shi
- Department of Neurosurgery, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Hong-Xiu Chen
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xiao-Han Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Qian-Qian Chen
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Ying-Qi Xing
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Park C, Ryu SJ, Jeong BH, Lee SP, Hong CK, Kim YB, Lee B. Real-Time Noninvasive Intracranial State Estimation Using Unscented Kalman Filter. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1931-1938. [PMID: 31380765 DOI: 10.1109/tnsre.2019.2932273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial pressure (ICP) monitoring is desirable as a first-line measure to assist decision-making in cases of increased ICP. Clinically, non-invasive ICP monitoring is also required to avoid infection and hemorrhage in patients. The relationships among the arterial blood pressure (ABP), ICP, cerebral blood flow, and its velocity ( [Formula: see text]) measured by transcranial Doppler ultrasound measurement have been reported. However, real-time non-invasive ICP estimation using these modalities is less well documented. This paper presents a novel algorithm for real-time and non-invasive ICP monitoring with [Formula: see text] and ABP, called direct-current (DC)-ICP. The technique was compared with invasive ICP for 10 acute-brain-injury patients admitted to Cheju Halla Hospital and Gangnam Severance Hospital from July 2017 to June 2018. The inter-subject correlation coefficient between true and estimate was 0.75 and the AUCs of the ROCs for prediction of increased ICP for the DC-ICP methods were 0.83. Thus, [Formula: see text] monitoring can facilitate reliable real-time ICP tracking with our novel DC-ICP algorithm, which can provide valuable information under clinical conditions.
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Wang D, Baker WB, He H, Gao P, Zhu L, Peng Q, Li Z, Li F, Chen T, Feng H. Influence of probe pressure on the pulsatile diffuse correlation spectroscopy blood flow signal on the forearm and forehead regions. NEUROPHOTONICS 2019; 6:035013. [PMID: 31548976 PMCID: PMC6755374 DOI: 10.1117/1.nph.6.3.035013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/04/2019] [Indexed: 05/24/2023]
Abstract
In a pilot study of 11 healthy adults (24 to 39 years, all male), we characterize the influence of external probe pressure on optical diffuse correlation spectroscopy (DCS) measurements of pulsatile blood flow obtained on the forearm and forehead. For external probe pressure control, a hand inflatable air balloon is inserted between the tissue and an elastic strap. The air balloon is sequentially inflated to achieve a wide range of external probe pressures between 20 and 250 mmHg on the forearm and forehead, which are measured with a flexible pressure sensor underneath the probe. At each probe pressure, the pulsatility index (PI) of arteriole blood flow on the forehead and forearm is measured with DCS (2.1-cm source-detector separation). We observe a strong correlation between probe pressure and PI on the forearm ( R = 0.66 , p < 0.001 ), but not on the forehead ( R = - 0.11 , p = 0.4 ). The forearm measurements demonstrate the sensitivity of the DCS PI to skeletal muscle tissue pressure, whereas the forehead measurements indicate that DCS PI measurements are not sensitive to scalp tissue pressure. Note, in contrast to pulsatility, the time-averaged DCS blood flow index on the forehead was significantly correlated with probe pressure ( R = - 0.55 , p < 0.001 ). This pilot data appears to support the initiation of more comprehensive clinical studies on DCS to detect trends in internal pressure in brain and skeletal muscle.
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Affiliation(s)
- Detian Wang
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Wesley B. Baker
- Children’s Hospital of Philadelphia, Division of Neurology, Philadelphia, Philadelphia, United States
| | - Hui He
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Peng Gao
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Liguo Zhu
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Qixian Peng
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Zeren Li
- China Academy of Engineering Physics, Institute of Fluid Physics, Mianyang, China
| | - Fei Li
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
| | - Tunan Chen
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
| | - Hua Feng
- Army Medical University, Southwest Hospital, Department of Neurosurgery, Chong Qing, China
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Chang T, Li L, Yang Y, Li M, Qu Y, Gao L. Transcranial Doppler Ultrasonography for the Management of Severe Traumatic Brain Injury After Decompressive Craniectomy. World Neurosurg 2019; 126:e116-e124. [DOI: 10.1016/j.wneu.2019.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
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Correlation between Glasgow coma scale and Jugular venous oxygen saturation in severe traumatic brain injury. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Montrief T, Alerhand S, Jewell C, Scott J. Incorporation of Transcranial Doppler into the ED for the neurocritical care patient. Am J Emerg Med 2019; 37:1144-1152. [PMID: 30894296 DOI: 10.1016/j.ajem.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/05/2019] [Accepted: 03/04/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION In the catastrophic neurologic emergency, a complete neurological exam is not always possible or feasible given the time-sensitive nature of the underlying disease process, or if emergent airway management is indicated. As the neurologic exam may be limited in some patients, the emergency physician is reliant on the assessment of brainstem structures to determine neurological function. Physicians thus routinely depend on advanced imaging modalities to further investigate for potential catastrophic diagnoses. Acquiring these tests introduces the risks of transport as well as delays in managing time-sensitive neurologic processes. A more immediate, non-invasive bedside approach complementing these modalities has evolved: Transcranial Doppler (TCD). OBJECTIVE This narrative review will provide a description of scenarios in which TCD may be applicable. It will summarize the sonographic findings and associated underlying pathophysiology in such neurocritical care patients. An illustrated tutorial, along with pearls and pitfalls, is provided. DISCUSSION Although there are numerous formalized TCD protocols utilizing four views (transtemporal, submandibular, suboccipital, and transorbital), point-of-care TCD is best accomplished through the transtemporal window. The core applications include the evaluation of midline shift, vasospasm after subarachnoid hemorrhage, acute ischemic stroke, and elevated intracranial pressure. An illustrative tutorial is provided. CONCLUSIONS With the wide dissemination of bedside ultrasound within the emergency department, there is a unique opportunity for the emergency physician to utilize TCD for a variety of conditions. While barriers to training exist, emergency physician performance of limited point-of-care TCD is feasible and may provide rapid and reliable clinical information with high temporal resolution.
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Affiliation(s)
- Tim Montrief
- Department of Emergency Medicine, Jackson Memorial Health System, Miami, FL 33136, USA.
| | - Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, USA
| | - Corlin Jewell
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Jeffery Scott
- Department of Emergency Medicine, Jackson Memorial Health System, Miami, FL 33136, USA
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Tan BY, Leong AZ, Leow AS, Ngiam NJ, Ng BS, Sharma M, Yeo LL, Seow PA, Hong CS, Chee YH, Chen J, Du Z, Wong LY, Batra A, Sarkar N, Teoh HL, Ho RC, Sharma VK. Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics. PLoS One 2019; 14:e0208724. [PMID: 30615620 PMCID: PMC6322770 DOI: 10.1371/journal.pone.0208724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Forest fires in South Asia lead to widespread haze, where many healthy individuals develop psychosomatic symptoms. We investigated the effects of haze exposure on cerebral hemodynamics and new symptoms. We hypothesised that vasoactive substances present in the haze, would lead to vasodilation of cerebral vasculature, thereby altering cerebral hemodynamics, which in turn may account for new psychosomatic symptoms. METHODS Seventy-four healthy volunteers were recruited, and serial transcranial Doppler (TCD) ultrasonography was performed to record blood flow parameters of bilateral middle cerebral arteries (MCA). The first TCD was performed in an air-conditioned environment. It was repeated outdoors after the participants spent 30-minutes in the haze environment. The prevailing level of pollutant standards index (PSI) was recorded. Appropriate statistical analyses were performed to compare cerebral hemodynamics at baseline and after haze exposure in all participants. Subgroup analyses were then employed to compare the findings between symptomatic and asymptomatic participants. RESULTS Study participants' median age was 30 years (IQR 26-34), and new psychosomatic symptoms were reported by 35 (47.3%). There was a modest but significant decrease in pulsatility index (PI) and resistivity index (RI) in the left MCA after haze exposure (PI: p = 0.026; RI: p = 0.021). When compared to baseline parameters, haze exposure resulted in significantly lower mean PI (p = 0.001) and RI (p = 0.001) in symptomatic patients, but this difference was not present in asymptomatic patients (PI: p = 0.919; RI: p = 0.970). CONCLUSION Haze causes significant alterations in cerebral hemodynamics in susceptible individuals, probably responsible for various psychosomatic symptoms. The prognostic implications and health effects of haze require evaluation in a larger study.
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Affiliation(s)
- Benjamin Y. Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Adriel Z. Leong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Aloysius S. Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas J. Ngiam
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Bridget S. Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Manasi Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard L. Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Philip A. Seow
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Chiew S. Hong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Young H. Chee
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Jintao Chen
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Zhengdao Du
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Lily Y. Wong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Amit Batra
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Nabin Sarkar
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Roger C. Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Health System, Singapore
| | - Vijay K. Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Fatima N, Shuaib A, Chughtai TS, Ayyad A, Saqqur M. The Role of Transcranial Doppler in Traumatic Brain Injury: A Systemic Review and Meta-Analysis. Asian J Neurosurg 2019; 14:626-633. [PMID: 31497078 PMCID: PMC6702999 DOI: 10.4103/ajns.ajns_42_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To evaluate whether transcranial Doppler (TCD) monitoring plays a role as a prognostic indicator, by being both a diagnostic as well as a monitoring tool for increased intracranial pressure and cerebral vasospasm (VSP), in traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to the present. Randomized control trials, case–control studies, and prospective cohort studies on TCD in TBI (>18 years old). Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and Extended GCOS and mortality. Data were extracted to Review Manager Software. Twenty-five articles that met the inclusion criteria were retrieved and analyzed. Ultimately, five studies were included in our meta-analysis, which revealed that patients with TBI with abnormal TCD (mean flow velocity [MFV] >120 cm/sec or MFV <35 cm/sec and Pulsatility Index >1.2) have a >3-fold higher likelihood of having poor clinical outcome in comparison to patients with TBI and normal TCD monitoring (odds ratio [OR]: 3.87; 95% confidence interval [CI]: 2.97–5.04; P < 0.00001). Subgroup analysis revealed that abnormal TCD has a 9-fold higher likelihood of mortality (OR: 9.96; 95% CI: 4.41–22.47; P < 0.00001). Further, subgroup analysis based on TCD findings revealed that the presence of hypoperfusion on TCD (middle cerebral artery [MCA] <35 cm/s) is associated with a three-fold higher likelihood of having poor functional outcome (OR: 3.72; 95% CI: 1.97–7.0; P < 0.0001). The presence of VSP (MCA >120 cm/s) is associated with three-fold higher likelihood of poor functional outcome (OR: 3.64; 95% CI: 1.55–8.52; P = 0.003). TCD is an evolving diagnostic tool that might play a role in determining the prognosis of patients with TBI. Further prospective study is needed to prove the role of TCD in TBI.
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Affiliation(s)
- Nida Fatima
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Neurology, Hamad General Hospital, Doha, Qatar
| | | | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
| | - Maher Saqqur
- Department of Neurology, Hamad General Hospital, Doha, Qatar
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Abecasis F, Oliveira V, Robba C, Czosnyka M. Transcranial Doppler in pediatric emergency and intensive care unit: a case series and literature review. Childs Nerv Syst 2018; 34:1465-1470. [PMID: 29955941 DOI: 10.1007/s00381-018-3877-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/21/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Transcranial Doppler (TCD) has been used for more than 30 years in clinical practice. Although adult intensive care is relatively well covered, pediatric cases are still underrepresented. We intend to review a series of pediatric cases where TCD was determinant in clinical decisions and a literature review on this topic. METHODS We describe cases with different pathologies where TCD had an important role in clinical management of the patients. We discuss TCD utility and potential role both in the emergency department and the intensive care unit. RESULTS Five patients with different neurologic insults are presented. TCD was useful in the identification of intracranial hypertension in traumatic brain injury, hydrocephalus and central nervous system infection; identification of decreased cerebral perfusion pressure in hypovolemic shock and the diagnosis of impending cerebral circulatory arrest in a child with meningococcal septicemia. We discuss how TCD can be used in emergency and intensive care settings, reviewing relevant literature and our own experience. CONCLUSIONS Non-invasive testing using TCD can aid clinical decisions. More widespread use of this technique will allow for better care of children with neurologic insults.
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Affiliation(s)
- Francisco Abecasis
- Pediatric Intensive Care Unit, Centro Hospitalar Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Vitor Oliveira
- Department of Neurology, Centro Hospitalar Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRSSS for Oncology, Genoa, Italy
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, UK.,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
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Shin SS, Huisman TAGM, Hwang M. Ultrasound Imaging for Traumatic Brain Injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1857-1867. [PMID: 29388231 DOI: 10.1002/jum.14547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Traumatic brain injury (TBI) is challenging to assess even with recent advancements in computed tomography and magnetic resonance imaging. Ultrasound (US) imaging has previously been less utilized in TBI compared to conventional imaging because of limited resolution in the intracranial space. However, there have been substantial improvements in contrast-enhanced US and development of novel techniques such as intravascular US. Also, continued research provides further insight into cerebrovascular parameters from transcranial Doppler imaging. These advancements in US imaging provides the community of TBI imaging researchers and clinicians new opportunities in clinically monitoring and understanding the pathologic mechanisms of TBI.
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Affiliation(s)
- Samuel S Shin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Misun Hwang
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Narayan V, Mohammed N, Savardekar AR, Patra DP, Notarianni C, Nanda A. Noninvasive Intracranial Pressure Monitoring for Severe Traumatic Brain Injury in Children: A Concise Update on Current Methods. World Neurosurg 2018. [PMID: 29524721 DOI: 10.1016/j.wneu.2018.02.159] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality worldwide and intracranial pressure (ICP) monitoring plays a crucial role in its management. Based on existing literature, we review the current practicing noninvasive ICP monitoring devices and their accuracy in predicting increased ICP in pediatric TBI. METHODS A thorough literature search was conducted on PubMed, Medline, and the Cochrane database, articles were selected systematically and reviewed completely, and relevant data were summarized and discussed. RESULTS A total of 27 articles pertaining to pediatric TBI were included and reviewed. We found various modalities of noninvasive ICP monitoring devices used over the last few years. The noninvasive modalities so far attempted in pediatric TBI and so reviewed here are transcranial Doppler, optic nerve sheath diameter, otoacoustic emission, near-infrared spectroscopy, contrast-enhanced ultrasonography, and quantitative pupillometry. CONCLUSIONS Invasive monitoring methods are the current gold standard for monitoring ICP; however, complications caused by their invasive nature are of concern. Of all the noninvasive methods based on the literature, we found transcranial Doppler and optic nerve sheath diameter assessment to be the best tools to monitor ICP in pediatric TBI. The promising results and developments of noninvasive ICP monitoring modalities with its ideal features of high sensitivity, diagnostic accuracy, and simple acquisition technique may make it the future of neurointensive monitoring in pediatric TBI.
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Affiliation(s)
- Vinayak Narayan
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Nasser Mohammed
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Amey R Savardekar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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Urban A, Golgher L, Brunner C, Gdalyahu A, Har-Gil H, Kain D, Montaldo G, Sironi L, Blinder P. Understanding the neurovascular unit at multiple scales: Advantages and limitations of multi-photon and functional ultrasound imaging. Adv Drug Deliv Rev 2017; 119:73-100. [PMID: 28778714 DOI: 10.1016/j.addr.2017.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 02/07/2023]
Abstract
Developing efficient brain imaging technologies by combining a high spatiotemporal resolution and a large penetration depth is a key step for better understanding the neurovascular interface that emerges as a main pathway to neurodegeneration in many pathologies such as dementia. This review focuses on the advances in two complementary techniques: multi-photon laser scanning microscopy (MPLSM) and functional ultrasound imaging (fUSi). MPLSM has become the gold standard for in vivo imaging of cellular dynamics and morphology, together with cerebral blood flow. fUSi is an innovative imaging modality based on Doppler ultrasound, capable of recording vascular brain activity over large scales (i.e., tens of cubic millimeters) at unprecedented spatial and temporal resolution for such volumes (up to 10μm pixel size at 10kHz). By merging these two technologies, researchers may have access to a more detailed view of the various processes taking place at the neurovascular interface. MPLSM and fUSi are also good candidates for addressing the major challenge of real-time delivery, monitoring, and in vivo evaluation of drugs in neuronal tissue.
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Affiliation(s)
- Alan Urban
- Neuroelectronics Research Flanders, Leuven, Belgium; VIB, Leuven, Belgium and/or IMEC, Leuven, Belgium; Department of Neurosciences, KU Leuven, Leuven, Belgium; Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Lior Golgher
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Clément Brunner
- Neuroelectronics Research Flanders, Leuven, Belgium; VIB, Leuven, Belgium and/or IMEC, Leuven, Belgium
| | - Amos Gdalyahu
- Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagai Har-Gil
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - David Kain
- Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Montaldo
- Neuroelectronics Research Flanders, Leuven, Belgium; VIB, Leuven, Belgium and/or IMEC, Leuven, Belgium
| | - Laura Sironi
- Physics Dept., Universita degli Studi di Milano Bicocca, Italy
| | - Pablo Blinder
- Neurobiology Dept., Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
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The value of midbrain morphology in predicting prognosis in chronic disorders of consciousness: A preliminary ultrasound study. J Neurol Sci 2017; 380:46-50. [PMID: 28870587 DOI: 10.1016/j.jns.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022]
Abstract
Transcranial sonography (TCS) of the brainstem is currently used to support the clinical diagnosis of movement disorders. The aim of the study was to assess the usefulness of midbrain TCS in assessing outcome in patients with Chronic Disorders of Consciousness (DOC). Eleven patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) were included in the study. We measured the area and echogenicity of the midbrain by encoding and digitally analyzing the corresponding images from the orbitomeatal plane, the morphology of brain parenchyma from the thalamic and cella media plane, and the intracranial circulation. All the patients showed an increase of pulsatility index and numerous morphological alterations on all the scan planes. In particular, we found a loss of the characteristic butterfly-shape of the midbrain, which appeared hypoechoic in the UWS but not in the MCS patients. After six months, the patients were clinically assessed by using Glasgow Outcome Scale Extended (GOSE). We found that a higher increase in GOSE scoring at follow-up was correlated with larger area and higher echogenicity of the midbrain at baseline. The present study suggests that TCS data of the midbrain may support clinical assessment of patients with chronic DOC to estimate their outcome.
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Viski S, Olah L. Use of Transcranial Doppler in Intensive Care Unit. ACTA ACUST UNITED AC 2017; 3:99-104. [PMID: 29967879 PMCID: PMC5769900 DOI: 10.1515/jccm-2017-0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
Use of transcranial Doppler has undergone much development since its introduction in 1982, making the technique suitable for general use in intensive care units. The main application in intensive care units is to assess intracranial pressure, confirm the lack of cerebral circulation in brain death, detect vasospasm in subarachnoid haemorrhage, and monitor the blood flow parameters during thrombolysis and carotid endarterectomy, as well as measuring stenosis of the main intracranial arteries in sickle cell disease in children. This review summarises the use of transcranial Doppler in intensive care units.
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Affiliation(s)
- Sandor Viski
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Laszlo Olah
- Department of Neurology, University of Debrecen, Móricz Zs. krt. 22, H-4032, Debrecen, Hungary
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Zhang X, Medow JE, Iskandar BJ, Wang F, Shokoueinejad M, Koueik J, Webster JG. Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas 2017; 38:R143-R182. [PMID: 28489610 DOI: 10.1088/1361-6579/aa7256] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Measurement of intracranial pressure (ICP) can be invaluable in the management of critically ill patients. Cerebrospinal fluid is produced by the choroid plexus in the brain ventricles (a set of communicating chambers), after which it circulates through the different ventricles and exits into the subarachnoid space around the brain, where it is reabsorbed into the venous system. If the fluid does not drain out of the brain or get reabsorbed, the ICP increases, which may lead to brain damage or death. ICP elevation accompanied by dilatation of the cerebral ventricles is termed hydrocephalus, whereas ICP elevation accompanied by normal or small ventricles is termed idiopathic intracranial hypertension. OBJECTIVE We performed a comprehensive literature review on how to measure ICP invasively and noninvasively. APPROACH This review discusses the advantages and disadvantages of current invasive and noninvasive approaches. MAIN RESULTS Invasive methods remain the most accurate at measuring ICP, but they are prone to a variety of complications including infection, hemorrhage and neurological deficits. Ventricular catheters remain the gold standard but also carry the highest risk of complications, including difficult or incorrect placement. Direct telemetric intraparenchymal ICP monitoring devices are a good alternative. Noninvasive methods for measuring and evaluating ICP have been developed and classified in five broad categories, but have not been reliable enough to use on a routine basis. These methods include the fluid dynamic, ophthalmic, otic, and electrophysiologic methods, as well as magnetic resonance imaging, transcranial Doppler ultrasonography (TCD), cerebral blood flow velocity, near-infrared spectroscopy, transcranial time-of-flight, spontaneous venous pulsations, venous ophthalmodynamometry, optical coherence tomography of retina, optic nerve sheath diameter (ONSD) assessment, pupillometry constriction, sensing tympanic membrane displacement, analyzing otoacoustic emissions/acoustic measure, transcranial acoustic signals, visual-evoked potentials, electroencephalography, skull vibrations, brain tissue resonance and the jugular vein. SIGNIFICANCE This review provides a current perspective of invasive and noninvasive ICP measurements, along with a sense of their relative strengths, drawbacks and areas for further improvement. At present, none of the noninvasive methods demonstrates sufficient accuracy and ease of use while allowing continuous monitoring in routine clinical use. However, they provide a realizable ICP measurement in specific patients especially when invasive monitoring is contraindicated or unavailable. Among all noninvasive ICP measurement methods, ONSD and TCD are attractive and may be useful in selected settings though they cannot be used as invasive ICP measurement substitutes. For a sufficiently accurate and universal continuous ICP monitoring method/device, future research and developments are needed to integrate further refinements of the existing methods, combine telemetric sensors and/or technologies, and validate large numbers of clinical studies on relevant patient populations.
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Affiliation(s)
- Xuan Zhang
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, United States of America
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Khan MN, Shallwani H, Khan MU, Shamim MS. Noninvasive monitoring intracranial pressure - A review of available modalities. Surg Neurol Int 2017; 8:51. [PMID: 28480113 PMCID: PMC5402331 DOI: 10.4103/sni.sni_403_16] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/26/2017] [Indexed: 12/28/2022] Open
Abstract
Background: Intracranial pressure (ICP) monitoring is important in many neurosurgical and neurological patients. The gold standard for monitoring ICP, however, is via an invasive procedure resulting in the placement of an intraventricular catheter, which is associated with many risks. Several noninvasive ICP monitoring techniques have been examined with the hope to replace the invasive techniques. The goal of this paper is to provide an overview of all modalities that have been used for noninvasive ICP monitoring to date. Methods: A thorough literature search was conducted on PubMed, selected articles were reviewed in completion, and pertinent data was included in the review. Results: A total of 94 publications were reviewed, and we found that over the past few decades clinicians have attempted to use a number of modalities to monitor ICP noninvasively. Conclusion: Although the intraventricular catheter remains the gold standard for monitoring ICP, several noninvasive modalities that can be used in settings when invasive monitoring is not possible are also available. In our opinion, measurement of optic nerve sheath diameter and pupillometry are the two modalities which may prove to be valid options for centers not performing invasive ICP monitoring.
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Affiliation(s)
| | - Hussain Shallwani
- Endovascular Research Fellow, University of Buffalo Neurosurgery, Buffalo, New York, USA
| | - Muhammad Ulusyar Khan
- Division of Biological and Biomedical Sciences, Aga Khan University Hospital, Karachi, Pakistan
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Reuter-Rice K. Transcranial Doppler Ultrasound Use in Pediatric Traumatic Brain Injury. JOURNAL OF RADIOLOGY NURSING 2017; 36:3-9. [PMID: 28947894 PMCID: PMC5609698 DOI: 10.1016/j.jradnu.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Transcranial Doppler ultrasound (TCD) is an inexpensive portable diagnostic tool commonly available within most healthcare systems. A team of trained individuals perform and interpret the test to inform patient care management. The benefit of TCD is well established in adult patients with traumatic brain injury. However, in children with TBI, it is still considered exploratory and its use is not a part of the standard of care. This article describes what TCD is, its use in children, and how TCD measurements apply to children and adolescents in an effort to establish criteria for the use of TCD for children with TBI. The benefit of TCD in pediatric TBI is illustrated by 2 cases of children who participated in a TBI research study. Early indications are that the use of TCD in pediatric cases of TBI may produce unexpected real-time data about the cerebral vasculature and circulation characteristics in children with TBI. Transcranial Doppler ultrasound has the potential for playing an informative diagnostic role in future pediatric TBI management. Ultimately the goal to promote best outcomes after a TBI requires insights into the multi-dynamic nature of the injury and TCD has the ability to support these efforts.
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Affiliation(s)
- Karin Reuter-Rice
- Associate Professor, Duke University, School of Nursing, School of Medicine, Dept. of Pediatrics, Duke Institute for Brain Science, 307 Trent Drive, DUMC 3322, Durham, NC, 27710
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Hatefi M, Behzadi S, Dastjerdi MM, Ghahnavieh AA, Rahmani A, Mahdizadeh F, Hafezi Ahmadi MR, Asadollahi K. Correlation of Homocysteine with Cerebral Hemodynamic Abnormality, Endothelial Dysfunction Markers, and Cognition Impairment in Patients with Traumatic Brain Injury. World Neurosurg 2017; 97:70-79. [DOI: 10.1016/j.wneu.2016.09.080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 02/04/2023]
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Cardim D, Robba C, Bohdanowicz M, Donnelly J, Cabella B, Liu X, Cabeleira M, Smielewski P, Schmidt B, Czosnyka M. Non-invasive Monitoring of Intracranial Pressure Using Transcranial Doppler Ultrasonography: Is It Possible? Neurocrit Care 2016; 25:473-491. [PMID: 26940914 PMCID: PMC5138275 DOI: 10.1007/s12028-016-0258-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although intracranial pressure (ICP) is essential to guide management of patients suffering from acute brain diseases, this signal is often neglected outside the neurocritical care environment. This is mainly attributed to the intrinsic risks of the available invasive techniques, which have prevented ICP monitoring in many conditions affecting the intracranial homeostasis, from mild traumatic brain injury to liver encephalopathy. In such scenario, methods for non-invasive monitoring of ICP (nICP) could improve clinical management of these conditions. A review of the literature was performed on PUBMED using the search keywords 'Transcranial Doppler non-invasive intracranial pressure.' Transcranial Doppler (TCD) is a technique primarily aimed at assessing the cerebrovascular dynamics through the cerebral blood flow velocity (FV). Its applicability for nICP assessment emerged from observation that some TCD-derived parameters change during increase of ICP, such as the shape of FV pulse waveform or pulsatility index. Methods were grouped as: based on TCD pulsatility index; aimed at non-invasive estimation of cerebral perfusion pressure and model-based methods. Published studies present with different accuracies, with prediction abilities (AUCs) for detection of ICP ≥20 mmHg ranging from 0.62 to 0.92. This discrepancy could result from inconsistent assessment measures and application in different conditions, from traumatic brain injury to hydrocephalus and stroke. Most of the reports stress a potential advantage of TCD as it provides the possibility to monitor changes of ICP in time. Overall accuracy for TCD-based methods ranges around ±12 mmHg, with a great potential of tracing dynamical changes of ICP in time, particularly those of vasogenic nature.
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Affiliation(s)
- Danilo Cardim
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - C Robba
- Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation, Cambridge, UK
| | - M Bohdanowicz
- Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - J Donnelly
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - B Cabella
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - X Liu
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - M Cabeleira
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - P Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - B Schmidt
- Department of Neurology, University Hospital Chemnitz, Chemnitz, Germany
| | - M Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Box 167, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Yang D, Cabral D, Gaspard EN, Lipton RB, Rundek T, Derby CA. Cerebral Hemodynamics in the Elderly: A Transcranial Doppler Study in the Einstein Aging Study Cohort. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1907-14. [PMID: 27417737 PMCID: PMC5500193 DOI: 10.7863/ultra.15.10040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/07/2015] [Indexed: 05/19/2023]
Abstract
OBJECTIVES We sought to describe the relationship between age, sex, and race/ethnicity with transcranial Doppler hemodynamic characteristics from major intracerebral arterial segments in a large elderly population with varying demographics. METHODS We analyzed 369 stroke-free participants aged 70 years and older from the Einstein Aging Study. Single-gate, nonimaging transcranial Doppler sonography, a noninvasive sonographic technique that assesses real-time cerebrovascular hemodynamics, was used to interrogate 9 cerebral arterial segments. Individual Doppler spectra and cerebral blood flow velocities were acquired, and the pulsatility index and resistive index were calculated by the device's automated waveform-tracking function. Multiple linear regression models were used to examine the independent associations of age, sex, and race/ethnicity with transcranial Doppler measures, adjusting for hypertension, history of myocardial infarction or revascularization, and history of diabetes. RESULTS Among enrolled participants, 303 individuals had at least 1 vessel insonated (mean age [SD], 80 [6] years; 63% women; 58% white; and 32% black). With age, transcranial Doppler measures of mean blood flow velocity were significantly decreased in the basilar artery (P = .001) and posterior cerebral artery (right, P = .003; left, P = .02). Pulsatility indices increased in the left middle cerebral artery (P = .01) and left anterior cerebral artery (P = .03), and the resistive index was increased in the left middle cerebral artery (P = .007) with age. Women had higher pulsatility and resistive indices compared to men in several vessels. CONCLUSIONS We report a decreased mean blood flow velocity and weakly increased arterial pulsatility and resistance with aging in a large elderly stroke-free population. These referential trends in cerebrovascular hemodynamics may carry important implications in vascular diseases associated with advanced age, increased risk of cerebrovascular disease, cognitive decline, and dementia.
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Affiliation(s)
- Dixon Yang
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Emmanuel N Gaspard
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
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D'Andrea A, Conte M, Cavallaro M, Scarafile R, Riegler L, Cocchia R, Pezzullo E, Carbone A, Natale F, Santoro G, Caso P, Russo MG, Bossone E, Calabrò R. Transcranial Doppler ultrasonography: From methodology to major clinical applications. World J Cardiol 2016; 8:383-400. [PMID: 27468332 PMCID: PMC4958690 DOI: 10.4330/wjc.v8.i7.383] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/29/2016] [Accepted: 05/17/2016] [Indexed: 02/06/2023] Open
Abstract
Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler (TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency (≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old. TCD also allows to classify the grade of severity of such shunts using the so called "microembolic signal grading score". In addition TCD has found many useful applications in neurocritical care practice. It is useful on both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoidal haemorrhage (caused by aneurysm rupture or traumatic injury), traumatic brain injury, brain stem death. It is used also to evaluate cerebral hemodynamic changes after stroke. It also allows to investigate cerebral pressure autoregulation and for the clinical evaluation of cerebral autoregulatory reserve.
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Affiliation(s)
- Antonello D'Andrea
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Marianna Conte
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Massimo Cavallaro
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Raffaella Scarafile
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Lucia Riegler
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Rosangela Cocchia
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Enrica Pezzullo
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Andreina Carbone
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Francesco Natale
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Giuseppe Santoro
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Pio Caso
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Maria Giovanna Russo
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Eduardo Bossone
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
| | - Raffaele Calabrò
- Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN "dei Colli", Monaldi Hospital, 80121 Naples, Italy
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Ziegler D, Cravens G, Poche G, Gandhi R, Tellez M. Use of Transcranial Doppler in Patients with Severe Traumatic Brain Injuries. J Neurotrauma 2016; 34:121-127. [PMID: 26913374 DOI: 10.1089/neu.2015.3967] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Severe traumatic brain injuries (TBI) are associated with a high rate of mortality and disability. Transcranial Doppler (TCD) sonography permits a noninvasive measurement of cerebral blood flow. The purpose of this study is to determine the usefulness of TCD in patients with severe TBI. TCD was performed, from April 2008 to April 2013, on 255 patients with severe TBI, defined as a Glasgow Coma Scale score of ≤8 on admission. TCD was performed on hospital days 1, 2, 3, and 7. Hypoperfusion was defined by having two out of three of the following: 1) mean velocity (Vm) of the middle cerebral artery <35 cm/sec, 2) diastolic velocity (Vd) of the middle cerebral artery <20 cm/sec, or 3) pulsatility index (PI) of >1.4. Vasospasm was defined by the following: Vm of the middle cerebral artery >120 cm/sec and/or a Lindegaard index (LI) >3. One hundred fourteen (45%) had normal measurements. Of these, 92 (80.7%) had a good outcome, 6 (5.3%) had moderate disability, and 16 (14%) died, 4 from brain death. Seventy-two patients (28%) had hypoperfusion and 71 (98.6%) died, 65 from brain death, and 1 patient survived with moderate disability. Sixty-nine patients (27%) had vasospasm, 31 (44.9%) had a good outcome, 16 (23.2%) had severe disability, and 22 (31.9%) died, 13 from brain death. The vasospasm was detected on hospital day 1 in 8 patients, on day 2 in 23 patients, on day 3 in 22 patients, and on day 7 in 16 patients. Patients with normal measurements can be expected to survive. Patients with hypoperfusion have a poor prognosis. Patients with vasospasm have a high incidence of mortality and severe disability. TCD is useful in determining early prognosis.
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Affiliation(s)
- Daniel Ziegler
- 1 Department of Surgery, John Peter Smith Hospital , Fort Worth, Texas
| | - George Cravens
- 2 Department of Neurosurgery, John Peter Smith Hospital , Fort Worth, Texas
| | - Gerard Poche
- 2 Department of Neurosurgery, John Peter Smith Hospital , Fort Worth, Texas
| | - Raj Gandhi
- 1 Department of Surgery, John Peter Smith Hospital , Fort Worth, Texas
| | - Mark Tellez
- 1 Department of Surgery, John Peter Smith Hospital , Fort Worth, Texas
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Abstract
The challenges posed by acute brain injury (ABI) involve the management of the initial insult in addition to downstream inflammation, edema, and ischemia that can result in secondary brain injury (SBI). SBI is often subclinical, but can be detected through physiologic changes. These changes serve as a surrogate for tissue injury/cell death and are captured by parameters measured by various monitors that measure intracranial pressure (ICP), cerebral blood flow (CBF), brain tissue oxygenation (PbtO2), cerebral metabolism, and electrocortical activity. In the ideal setting, multimodality monitoring (MMM) integrates these neurological monitoring parameters with traditional hemodynamic monitoring and the physical exam, presenting the information needed to clinicians who can intervene before irreversible damage occurs. There are now consensus guidelines on the utilization of MMM, and there continue to be new advances and questions regarding its use. In this review, we examine these recommendations, recent evidence for MMM, and future directions for MMM.
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Affiliation(s)
- David Roh
- Department of Neurology and Neurocritical Care, Columbia University, 177 Fort Washington Ave, New York, NY 10032, USA
| | - Soojin Park
- Department of Neurology and Neurocritical Care, Columbia University, 177 Fort Washington Ave, New York, NY 10032, USA
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Abnormal transcranial Doppler cerebral blood flow velocity and blood pressure profiles in children with syndromic craniosynostosis and papilledema. J Craniomaxillofac Surg 2016; 44:465-70. [PMID: 26857754 DOI: 10.1016/j.jcms.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/09/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Children with syndromic craniosynostosis are at risk of intracranial hypertension. This study aims to examine patient profiles of transcranial Doppler (TCD) cerebral blood flow velocity (CBFv) and systemic blood pressure (BP) in subjects with and without papilledema at the time of surgery, and subsequent effect of cranial vault expansion. METHODS Prospective study of patients treated at a national referral center. Patients underwent TCD of the middle cerebral artery 1 day before and 3 weeks after surgery. Measurements included mean CBFv, peak systolic velocity, and end diastolic velocity; age-corrected resistive index (RI) was calculated. Systemic BP was recorded. Papilledema was used to indicate intracranial hypertension. RESULTS Twelve patients (mean age 3.1 years, range 0.4-9.5) underwent TCD; 6 subjects had papilledema. Pre-operatively, patients with papilledema, in comparison to those without, had higher TCD values, RI, and BP (all p = 0.04); post-operatively, the distinction regarding BP remained (p = 0.04). There is a significant effect of time following vault surgery with a decrease in RI (p < 0.01). CONCLUSION Patients with syndromic craniosynostosis who have papilledema have a different TCD profile with raised BP. Vault surgery results in increased CBFv and decrease in RI, however the associated systemic BP response to intracranial hypertension remained at short-term follow-up.
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D'Andrea A, Conte M, Scarafile R, Riegler L, Cocchia R, Pezzullo E, Cavallaro M, Carbone A, Natale F, Russo MG, Gregorio G, Calabrò R. Transcranial Doppler Ultrasound: Physical Principles and Principal Applications in Neurocritical Care Unit. J Cardiovasc Echogr 2016; 26:28-41. [PMID: 28465958 PMCID: PMC5224659 DOI: 10.4103/2211-4122.183746] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied on both outpatient and inpatient settings. It involves the use of a low-frequency (≤2 MHz) transducer, placed on the scalp, to insonate the basal cerebral arteries through relatively thin bone windows and to measure the cerebral blood flow velocity and its alteration in many different conditions. In neurointensive care setting, TCD is useful for both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, and brain stem death. It also allows to investigate the cerebrovascular autoregulation in setting of carotid disease and syncope. In this review, we will describe physical principles underlying TCD, flow indices most frequently used in clinical practice and critical care applications in Neurocritical Unit care.
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Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Marianna Conte
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Raffaella Scarafile
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Lucia Riegler
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Rosangela Cocchia
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Enrica Pezzullo
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Massimo Cavallaro
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Andreina Carbone
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Francesco Natale
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
| | - Giovanni Gregorio
- Department of Cardiology, San Luca Hospital, Vallo della Lucania, Salerno, Italy
| | - Raffaele Calabrò
- Department of Cardiology, Integrated Diagnostic Cardiology, Second University of Neaples, Monaldi Hospital, Neaples, Italy
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Morgalla MH, Magunia H. Noninvasive measurement of intracranial pressure via the pulsatility index on transcranial Doppler sonography: Is improvement possible? JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:40-45. [PMID: 26366515 DOI: 10.1002/jcu.22279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 04/27/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE We hypothesized that using hemodynamic variables could improve the prediction of intracranial pressure (ICP) from the middle cerebral artery pulsatility index (PI) measured with transcranial Doppler sonography. METHODS In this prospective study, 39 patients with traumatic brain injury were routinely examined with transcranial Doppler sonography, and the middle cerebral artery PI was calculated. A multivariate model including hematocrit, mean arterial blood pressure, heart rate, and arterial CO2 pressure (PaCO2 ) was evaluated. RESULTS Thirty-nine comatose patients (16 women and 23 men; age range 18-73 years; median 44 years) were included, and 234 data pairs (consisting of ICP and corresponding PI values) were analyzed. ICP ranged from -3 mmHg to +52 mmHg, and PI from 0.6 to 2.85. We found a significant but weak correlation between PI and the square root of ICP (R(2) between 0.29 and 0.34, p < 0.0001). A slightly stronger correlation was detected when hemodynamic variables were incorporated (R(2) between 0.37 and 0.43). Of these variables, mean arterial blood pressure had the most significant influence. CONCLUSIONS In this study, PI was not a sufficiently strong predictor of ICP to be used in clinical practice. Its reliability did not improve even when hemodynamic variables were considered. Therefore, we recommend abandoning the use of PI for the noninvasive measurement of ICP in clinical practice.
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Affiliation(s)
- Matthias H Morgalla
- Clinic of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Str. 3, D-72076, Tuebingen, Germany
| | - Harry Magunia
- Clinic of Anaesthetics, University of Tuebingen, Hoppe-Seyler-Str. 3, D-72076, Tuebingen, Germany
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Tarzamni MK, Derakhshan B, Meshkini A, Merat H, Fouladi DF, Mostafazadeh S, Rezakhah A. The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure. Clin Neurol Neurosurg 2015; 141:82-8. [PMID: 26771156 DOI: 10.1016/j.clineuro.2015.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/02/2015] [Accepted: 12/10/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the diagnostic accuracy of ultrasonographic optic nerve sheath diameter (ONSD) measurement and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure (ICP). PATIENTS AND METHODS A total 60 patients with (cases, n=30) and without (controls, n=30) acute clinical and computed tomographic findings of elevated ICP due to intracranial mass/hemorrhage were recruited from a teaching hospital. The mean binocular and maximum ultrasonographic ONSDs, as well as the mean binocular Doppler ultrasound waveform indices of the ophthalmic arteries including pulsatility index (PI), resistive index (RI), end-systolic velocity (ESV), peak systolic velocity (PSV) and end-diastolic velocity (EDV) were compared between the two groups. RESULTS Compared to controls, the case group had significantly higher mean binocular ONSD (5.48 ± 0.52 mm vs. 4.09 ± 0.22 mm, p<0.001), maximum ONSD (5.63 ± 0.55 mm vs. 4.16 ± 0.23 mm, p<0.001), mean PI (1.53 ± 0.16 vs. 1.45 ± 0.20, p=0.01), and mean RI (0.76 ± 0.07 vs. 0.73 ± 0.04, p=0.01). The mean EDV, in contrast, was significantly higher in controls (8.55 ± 3.09 m/s vs. 7.17 ± 2.61 m/s, p=0.01). The two groups were comparable for the mean PSV (30.73 ± 7.93 m/s in cases vs. 32.27 ± 10.39 m/s in controls, p=0.36). Among the mentioned variables, the mean binocular ONSD was the most accurate parameter in detecting elevated ICP (sensitivity and specificity of 100%, cut-off point=4.53 mm). The Doppler indices were only moderately accurate (sensitivity: 56.7-60%, specificity: 63.3-76.7%). CONCLUSION While the ultrasonographic mean binocular ONSD (>4.53 mm) was completely accurate in detecting elevated ICP, color Doppler indices of the ophthalmic arteries were of limited value.
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Affiliation(s)
- Mohammad Kazem Tarzamni
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Derakhshan
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Meshkini
- Department of Neurosurgery, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Merat
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Samira Mostafazadeh
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Rezakhah
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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