Neurocritical Care

, 10:326

Transcranial Doppler Ultrasonography in the Assessment of Cerebral Circulation Arrest: Improving Sensitivity by Trancervical and Transorbital Carotid Insonation and Serial Examinations

Authors

    • Department of NeurosurgeryUniversity of Messina, Policlinico Universitario
  • Domenico G. Iacopino
    • Department of NeurosurgeryUniversity of Palermo
  • Antonella Spada
    • Department of Intensive CareUniversity of Messina
  • Salvatore M. Cardali
    • Department of NeurosurgeryUniversity of Messina, Policlinico Universitario
  • Maria Giusa
    • Department of NeurosurgeryUniversity of Messina, Policlinico Universitario
  • Domenico La Torre
    • Department of NeurosurgeryUniversity of Messina, Policlinico Universitario
  • Alfredo Campennì
    • Department of Nuclear MedicineUniversity of Messina
  • Olivia Penna
    • Department of Intensive CareUniversity of Messina
  • Sergio Baldari
    • Department of Nuclear MedicineUniversity of Messina
  • Francesco Tomasello
    • Department of NeurosurgeryUniversity of Messina, Policlinico Universitario
Original Article

DOI: 10.1007/s12028-009-9199-7

Cite this article as:
Conti, A., Iacopino, D.G., Spada, A. et al. Neurocrit Care (2009) 10: 326. doi:10.1007/s12028-009-9199-7

Abstract

Introduction

Transcranial Doppler (TCD) can detect the cerebral circulation arrest (CCA) in brain death. TCD is highly specific, but less sensitive because of false-negatives accounting for up to 10%. The aim of the study was to explore the diagnostic accuracy of TCD and to determine whether it can be augmented by strategies such as the insonation of the extracranial internal carotid artery (ICA) and sequential examinations.

Methods

Data of 184 patients, who met clinical criteria of brain death, observed from 1998 through 2006, were retrospectively reviewed. The study of cerebral arteries was performed through the transtemporal approach, suboccipital insonation of the vertebro-basilar system, transorbital insonation of the ICA and ophthalmic artery, and transcervical insonation of the extracranial ICA. Repeated exams were performed in cases of persistent diastolic flow.

Results

The specificity of the testing was 100%, no false-positive cases were recorded. The sensitivity of conventional TCD examination was 82.1%. The insonation of the extracranial ICA increased sensitivity to 88% allowing the detection of CCA in those patients lacking temporal windows; serial examinations further increased sensitivity to 95.6%.

Conclusions

The addition of insonation of the cervical ICA and of the siphon increased sensitivity of TCD. Nevertheless, a CCA flow patterns may appear later on those segments. Serial examinations, may be needed in those cases.

Keywords

Transcranial Doppler ultrasonographyCerebral circulatory arrestBrain deathSpecificity and sensitivity

Abbreviations

TCD

Transcranial Doppler

CCA

Cerebral circulation arrest

ICA

Internal carotid artery

CBF

Cerebral blood flow

HMPAO

Hexamethylpropyleneaminoxime

MCA

Middle cerebral artery

ACA

Anterior cerebral artery

BA

Basilar artery

ICP

Intracranial pressure

SPECT

Single photon emission computed tomography

ABP

Arterial blood pressure

CPP

Cerebral perfusion pressure

Copyright information

© Humana Press Inc. 2009