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Acute Neurologic Injury in the ICU: Role of Transcranial Doppler in Disorders of the Vertebrobasilar Circulation

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Neurosonology in Critical Care

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Abstract

Transcranial Doppler (TCD) ultrasound of the vertebrobasilar system offers a practical, non-invasive evaluation of the posterior circulation and may be helpful in the identification of cerebral vasospasm, intracranial vascular stenotic disease, and microembolus signal detection. Hemodynamics of the posterior circulation can be assessed using ultrasound in stroke and traumatic brain injury (TBI) and basilar artery flow characteristics are part of the complete TCD assessment for brain death. Cerebral autoregulation and vascular reactivity can offer insight into brain health in the posterior circulation, particularly in TBI. While anatomic limitations exist, size, patency, direction, and velocity of flow as well as microembolus detection are all feasible in the vertebrobasilar circulation using ultrasound.

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Author information

Authors and Affiliations

  1. Department of Neurology, Loyola University, Chicago, IL, USA

    Rick R. Gill

  2. Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA

    Brett L. Cucchiara

  3. HUP Neuro ICU, Philadelphia, PA, USA

    Monisha A. Kumar

  4. HUP Neuro ICU, Departments of Neurology, Neurosurgery and Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Monisha A. Kumar

  5. University of Pennsylvania Health System, Philadelphia, PA, USA

    Monisha A. Kumar

Authors
  1. Rick R. Gill
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  2. Brett L. Cucchiara
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  3. Monisha A. Kumar
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Corresponding author

Correspondence to Monisha A. Kumar .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Buenos Aires, Buenos Aires, Argentina

    Camilo N. Rodríguez

  2. Stroke Unit & Neurosonology Lab, University of Padua School of Medicine, Padova, Italy

    Claudio Baracchini

  3. Department of Critical Care and Anesthesiology, Fundación Valle del Lili, Cali, Colombia

    Jorge H. Mejia-Mantilla

  4. Department of Clinical Neurosciences Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK

    Marek Czosnyka

  5. Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I Suarez

  6. President of Hungarian Neurological Society, Department of Neurology, Clinical Center Debrecen University, Debrecen, Hungary

    László Csiba

  7. Intensive Care Unit, Clinics Hospital, Universidad de la Republica School of Medicine, Montevideo, Uruguay

    Corina Puppo

  8. Center for Neurological Vascular Diagnostics, Munich, Germany

    Eva Bartels

Appendices

Algorithm 27.1 TCD/TCCS: Use of Posterior Circulation in Diagnosis of Acute Brain injury

figure a

ABCD Airway-breathing-circulation-disability, CBFV Blood flow velocity, MFV Mean flow velocity, VA Vertebral artery, BA Basilar artery, PI Pulsatility index, PCA Posterior cerebral artery

Algorithm 27.2 Monitoring disease states with posterior circulation TCD/TCCS

figure b

ABCD Airway-breathing-circulation-disability, CBFV cerebral Blood flow velocity, PI Pulsatility index, PSV Peak systolic velocity, EDV End-diastolic velocity, MES microemboli signal, BA Basilar artery, VA vertebral artery, ABP arterial blood pressure, ICP intracranial pressure, CPP cerebral perfusion pressure, CMD cerebral micro-dialysis, CA cerebral autoregulation, VMR vasomotor reactivity, CBF cerebral blood flow

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Gill, R.R., Cucchiara, B.L., Kumar, M.A. (2022). Acute Neurologic Injury in the ICU: Role of Transcranial Doppler in Disorders of the Vertebrobasilar Circulation. In: Rodríguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_27

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