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Transcranial Doppler: Practical Applications

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Neurocritical Care for Neurosurgeons

Abstract

Transcranial Doppler (TCD) is a noninvasive method used for hemodynamic brain assessment. It has vast applicability in neurology, neurosurgery, and intensive care, enabling the diagnosis and monitoring of cerebral blood flow impairment secondary to different diseases. This exam uses a low-frequency probe positioned on the skull and obtains the blood flow velocity spectra of some brain arteries. Thus, it becomes a great tool in the functional assessment of intracranial circulation in ischemic cerebrovascular disease with and without intra- and extracranial arterial disease, monitoring of diseases that can lead to intracranial hypertension, such as subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI), measurement of hemodynamic repercussions in systemic diseases (sepsis and liver failure), complementary diagnosis of brain death and follow-up in sickle cell anemia, among other entities. This chapter will cover the basic principles of TCD and its main clinical applications.

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References

  1. Aaslid R, Markwalder TM, Nornes H. Non-invasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982;57(6):769–74.

    Article  CAS  PubMed  Google Scholar 

  2. Mccartney JP. In: Thomas-Lukes, Kathleen M, Gomez CR, editors. Handbook of transcranial Doppler. New York: Springer; 1997.

    Chapter  Google Scholar 

  3. Arenillas JF, Molina CA, Montaner J, Abilleira S, Gonzalez-Sanchez MA, Alvarez-Sabin J. Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study. Stroke. 2001;32(12):2898–904.

    Article  CAS  PubMed  Google Scholar 

  4. Moppett IK, Mahajan RP. Transcranial Doppler ultrasonography in anaesthesia and intensive care. Br J Anaesth. 2004;93(5):710–24.

    Article  CAS  PubMed  Google Scholar 

  5. Muller M, Voges M, Piepgras U, Schimrigk K. Assessment of cerebral vasomotor reactivity by transcranial Doppler ultrasound and breath-holding. A comparison with acetazolamide as vasodilatory stimulus. Stroke. 1995;26(1):96–100.

    Article  CAS  PubMed  Google Scholar 

  6. Panerai RB. Assessment of cerebral pressure autoregulation in humans--a review of measurement methods. Physiol Meas. 1998;19(3):305–38.

    Article  CAS  PubMed  Google Scholar 

  7. Moreno JA, Mesalles E, Gener J, Tomasa A, Ley A, Roca J, et al. Evaluating the outcome of severe head injury with transcranial Doppler ultrasonography. Neurosurg Focus. 2000;8(1):e8.

    Article  CAS  PubMed  Google Scholar 

  8. Rigamonti A, Ackery A, Baker AJ. Transcranial Doppler monitoring in subarachnoid hemorrhage: a critical tool in critical care. Can J Anaesth. 2008;55(2):112–23.

    Article  PubMed  Google Scholar 

  9. Christou I, Felberg RA, Demchuk AM, Grotta JC, Burgin WS, Malkoff M, et al. A broad diagnostic battery for bedside transcranial Doppler to detect flow changes with internal carotid artery stenosis or occlusion. J Neuroimaging. 2001;11(3):236–42.

    Article  CAS  PubMed  Google Scholar 

  10. Pierrakos C, Attou R, Decorte L, Kolyviras A, Malinverni S, Gottignies P, et al. Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients. BMC Anesthesiol. 2014;14:45.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Adams RJ. TCD in sickle cell disease: an important and useful test. Pediatr Radiol. 2005;35(3):229–34.

    Article  PubMed  Google Scholar 

  12. Ropper AH, Kehne SM, Wechsler L. Transcranial Doppler in brain death. Neurology. 1987;37(11):1733–5.

    Article  CAS  PubMed  Google Scholar 

  13. Ringelstein EB. A pratical guide to transcanial Doppler sonography. Non-invasive imaging of cerebrovascular disease: Alan R Liss, Inc; 1989. p. 75–121.

    Google Scholar 

  14. Fjioka KA, Douville CM. Anatomy and freehand examination techniques. In: Dwar N, editor. Transcranial Doppler. New York: Raven Press; 1992. p. 9–31.

    Google Scholar 

  15. Titianova E, Vastagh I. TCD protocol. In: ILCCB, editor. Manual of neurosonology Cambridge: Cambridge University Press; 2016.

    Google Scholar 

  16. Alexandrov A. Cerebrovascular ultrasound in stroke prevention and treatment: Blackwell Publishing; 2003.

    Google Scholar 

  17. Nicoletto HA, Burkman MH. Transcranial Doppler series part II: performing a transcranial Doppler. Am J Electroneurodiagnostic Technol. 2009;49(1):14–27.

    Article  PubMed  Google Scholar 

  18. White H, Venkatesh B. Applications of transcranial Doppler in the ICU: a review. Intensive Care Med. 2006;32(7):981–94.

    Article  PubMed  Google Scholar 

  19. Schatlo B, Pluta RM. Clinical applications of transcranial Doppler sonography. Rev Recent Clin Trials. 2007;2(1):49–57.

    Article  PubMed  Google Scholar 

  20. Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med. 1974;67(6 Pt 1):447–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Nicoletto HA, Burkman MH. Transcranial Doppler series part III: interpretation. Am J Electroneurodiagnostic Technol. 2009;49(3):244–59.

    Article  PubMed  Google Scholar 

  22. Nicoletto HA, Burkman MH. Transcranial Doppler series part IV: case studies. Am J Electroneurodiagnostic Technol. 2009;49(4):342–60.

    Article  PubMed  Google Scholar 

  23. Homburg AM, Jakobsen M, Enevoldsen E. Transcranial Doppler recordings in raised intracranial pressure. Acta Neurol Scand. 1993;87(6):488–93.

    Article  CAS  PubMed  Google Scholar 

  24. Aaslid R, Huber P, Nornes H. Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg. 1984;60(1):37–41.

    Article  CAS  PubMed  Google Scholar 

  25. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebral vasospasm after subarachnoid haemorrhage investigated by means of transcranial Doppler ultrasound. Acta Neurochir Suppl (Wien). 1988;42:81–4.

    CAS  Google Scholar 

  26. Gur A, Csányi A, Bornstein NM. Vasomotor reactivity. In: Baracchini C, Csiba L, editors. Manual of neurosonology. Cambridge: Cambridge University Press; 2016. p. 228–38.

    Chapter  Google Scholar 

  27. Markus HS, Harrison MJ. Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke. 1992;23(5):668–73.

    Article  CAS  PubMed  Google Scholar 

  28. Nicoletto HA, Boland LS. Transcranial Doppler series part v: specialty applications. Am J Electroneurodiagnostic Technol. 2011;51(1):31–41.

    Article  PubMed  Google Scholar 

  29. Taccone FS, Su F, Pierrakos C, He X, James S, Dewitte O, et al. Cerebral microcirculation is impaired during sepsis: an experimental study. Crit Care. 2010;14(4):R140-R.

    Article  Google Scholar 

  30. Cardim D, Robba C, Bohdanowicz M, Donnelly J, Cabella B, Liu X, et al. Non-invasive monitoring of intracranial pressure using transcranial Doppler ultrasonography: is it possible? Neurocrit Care. 2016;25(3):473–91.

    Article  PubMed  PubMed Central  Google Scholar 

  31. de Lima OM, Paiva W, Teixeira MJ, Bor-Seng-Shu E. Brain metabolic crisis in traumatic brain injury: what does it mean? J Neurotrauma. 2014;31(20):1750–1.

    Article  Google Scholar 

  32. de Lima OM, de Azevedo DS, de Azevedo MK, de Carvalho NR, Teixeira MJ, Bor-Seng-Shu E. Encephalic hemodynamic phases in subarachnoid hemorrhage: how to improve the protective effect in patient prognoses. Neural Regen Res. 2015;10(5):748–52.

    Article  Google Scholar 

  33. de Lima OM, Kairalla AC, Fonoff ET, Martinez RCR, Teixeira MJ, Bor-Seng-Shu E. Cerebral microdialysis in traumatic brain injury and subarachnoid hemorrhage: state of the art. Neurocrit Care. 2014;21(1):152–62.

    Google Scholar 

  34. Soehle M, Chatfield DA, Czosnyka M, Kirkpatrick PJ. Predictive value of initial clinical status, intracranial pressure and transcranial Doppler pulsatility after subarachnoid haemorrhage. Acta Neurochir. 2007;149(6):575–83.

    Article  CAS  PubMed  Google Scholar 

  35. Bor-Seng-Shu E, Kita WS, Figueiredo EG, Paiva WS, Fonoff ET, Teixeira MJ, et al. Cerebral hemodynamics: concepts of clinical importance. Arq Neuropsiquiatr. 2012;70(5):352–6.

    Article  PubMed  Google Scholar 

  36. Nogueira RC, Bor-Seng-Shu E, Santos MR, Negrão CE, Teixeira MJ, Panerai RB. Dynamic cerebral autoregulation changes during sub-maximal handgrip maneuver. PLoS One. 2013;8(8):e70821-e.

    Article  CAS  Google Scholar 

  37. Bor-Seng-Shu E, de-Lima-Oliveira M, Teixeira MJ, Panerai RB. Predicting symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2011;69(2):E501–E2.

    Article  PubMed  Google Scholar 

  38. Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, et al. Assessment: transcranial Doppler ultrasonography: report of the therapeutics and technology assessment Subcommittee of the American Academy of Neurology. Neurology. 2004;62(9):1468–81.

    Article  CAS  PubMed  Google Scholar 

  39. Kalanuria A, Nyquist PA, Armonda RA, Razumovsky A. Use of Transcranial Doppler (TCD) ultrasound in the Neurocritical Care Unit. Neurosurg Clin N Am. 2013;24(3):441–56.

    Article  PubMed  Google Scholar 

  40. Lee JH, Kelly DF, Oertel M, McArthur DL, Glenn TC, Vespa P, et al. Carbon dioxide reactivity, pressure autoregulation, and metabolic suppression reactivity after head injury: a transcranial Doppler study. J Neurosurg. 2001;95(2):222–32.

    Article  CAS  PubMed  Google Scholar 

  41. Steiner LA, Coles JP, Czosnyka M, Minhas PS, Fryer TD, Aigbirhio FI, et al. Cerebrovascular pressure reactivity is related to global cerebral oxygen metabolism after head injury. J Neurol Neurosurg Psychiatry. 2003;74(6):765–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Cruz J. Traumatic brain ischemia during neuro intensive care: myth rather than fact. Arq Neuropsiquiatr. 2001;59(3-A):479–82.

    Article  CAS  PubMed  Google Scholar 

  43. Graham DI, Ford I, Adams JH, Doyle D, Teasdale GM, Lawrence AE, et al. Ischaemic brain damage is still common in fatal non-missile head injury. J Neurol Neurosurg Psychiatry. 1989;52(3):346–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. McQuire JC, Sutcliffe JC, Coats TJ. Early changes in middle cerebral artery blood flow velocity after head injury. J Neurosurg. 1998;89(4):526–32.

    Article  CAS  PubMed  Google Scholar 

  45. Hassler W, Steinmetz H, Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg. 1988;68(5):745–51.

    Article  CAS  PubMed  Google Scholar 

  46. Paschoal FM Jr, Bor-Seng-Shu E, Teixeira MJ. Transcranial Doppler ultrasonography with jugular vein compression can detect impairment of intracranial compliance. Clin Neurol Neurosurg. 2013;115(7):1196–8.

    Article  PubMed  Google Scholar 

  47. Alexandrov AV, Sloan MA, Wong LKS, Douville C, Razumovsky AY, Koroshetz WJ, et al. Practice standards for transcranial Doppler ultrasound: part I--test performance. J Neuroimag: Off J Ame Soc Neuroimag. 2007;17(1):11–8.

    Article  Google Scholar 

  48. Rha J-H, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967–73.

    Article  PubMed  Google Scholar 

  49. Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke. 2007;38(3):948–54.

    Article  PubMed  Google Scholar 

  50. Tsivgoulis G, Alexandrov AV, Sloan MA. Advances in transcranial Doppler ultrasonography. Curr Neurol Neurosci Rep. 2009;9(1):46–54.

    Article  PubMed  Google Scholar 

  51. Anzola GP, Gasparotti R, Magoni M, Prandini F. Transcranial Doppler sonography and magnetic resonance angiography in the assessment of collateral hemispheric flow in patients with carotid artery disease. Stroke. 1995;26(2):214–7.

    Article  CAS  PubMed  Google Scholar 

  52. Tsivgoulis G, Sharma VK, Hoover SL, Lao AY, Ardelt AA, Malkoff MD, et al. Applications and advantages of power motion-mode Doppler in acute posterior circulation cerebral ischemia. Stroke. 2008;39(4):1197–204.

    Article  PubMed  Google Scholar 

  53. Müller M, Voges M, Piepgras U, Schimrigk K. Assessment of cerebral vasomotor reactivity by transcranial Doppler ultrasound and breath-holding. A comparison with acetazolamide as vasodilatory stimulus. Stroke. 1995;26(1):96–100.

    Article  PubMed  Google Scholar 

  54. Vernieri F, Pasqualetti P, Diomedi M, Giacomini P, Rossini PM, Caltagirone C, et al. Cerebral hemodynamics in patients with carotid artery occlusion and contralateral moderate or severe internal carotid artery stenosis. J Neurosurg. 2001;94(4):559–64.

    Article  CAS  PubMed  Google Scholar 

  55. Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, Rossini PM, et al. Effect of collateral blood flow and cerebral vasomotor reactivity on the outcome of carotid artery occlusion. Stroke. 2001;32(7):1552–8.

    Article  CAS  PubMed  Google Scholar 

  56. Silvestrini M, Vernieri F, Pasqualetti P, Matteis M, Passarelli F, Troisi E, et al. Impaired cerebral vasoreactivity and risk of stroke in patients with asymptomatic carotid artery stenosis. JAMA. 2000;283(16):2122–7.

    Article  CAS  PubMed  Google Scholar 

  57. Apruzzese A, Silvestrini M, Floris R, Vernieri F, Bozzao A, Hagberg G, et al. Cerebral hemodynamics in asymptomatic patients with internal carotid artery occlusion: a dynamic susceptibility contrast MR and transcranial Doppler study. AJNR Am J Neuroradiol. 2001;22(6):1062–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Nedeltchev K, Mattle HP. Contrast-enhanced transcranial Doppler ultrasound for diagnosis of patent foramen ovale. Front Neurol Neurosci. 2006;21:206–15.

    Article  PubMed  Google Scholar 

  59. Horner S. Right-to-left shunt detection. In: Baracchini C, Csiba L, editors. Manual of neurosonology. Cambridge: Cambridge University Press; 2016. p. 206–14.

    Chapter  Google Scholar 

  60. Macías-Rodríguez RU, Duarte-Rojo A, Cantú-Brito C, Sauerbruch T, Ruiz-Margáin A, Trebicka J, et al. Cerebral haemodynamics in cirrhotic patients with hepatic encephalopathy. Liver Int. 2015;35(2):344–52.

    Article  PubMed  CAS  Google Scholar 

  61. Paschoal FMJ, Nogueira RC, Oliveira ML, Paschoal EHA, Teixeira MJ, D’Albuquerque LAC, et al. Cerebral hemodynamic and metabolic changes in fulminant hepatic failure. Arq Neuropsiquiatr. 2017;75(7):470–6.

    Article  PubMed  Google Scholar 

  62. Paschoal-Jr FM, Nogueira RC, de-Lima-Oliveira M, Paschoal EH, Teixeira MJ, D’Albuquerque LA, et al. Cerebral autoregulation in a fulminant hepatic failure patient who underwent liver transplantation. Ann Hepatol. 2019;18(2):403–4.

    Article  PubMed  Google Scholar 

  63. Pierrakos C, Antoine A, Velissaris D, Michaux I, Bulpa P, Evrard P, et al. Transcranial doppler assessment of cerebral perfusion in critically ill septic patients: a pilot study. Ann Intensive Care. 2013;3:28.

    Article  PubMed  PubMed Central  Google Scholar 

  64. de Azevedo DS, Salinet ASM, de Lima OM, Teixeira MJ, Bor-Seng-Shu E, de Carvalho Nogueira R. Cerebral hemodynamics in sepsis assessed by transcranial Doppler: a systematic review and meta-analysis. J Clin Monit Comput. 2017;31(6):1123–32.

    Article  PubMed  Google Scholar 

  65. Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998;339(1):5–11.

    Article  CAS  PubMed  Google Scholar 

  66. Adams RJ. Lessons from the stroke prevention trial in sickle cell anemia (STOP) study. J Child Neurol. 2000;15(5):344–9.

    Article  CAS  PubMed  Google Scholar 

  67. Pegelow CH, Wang W, Granger S, Hsu LL, Vichinsky E, Moser FG, et al. Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity. Arch Neurol. 2001;58(12):2017–21.

    Article  CAS  PubMed  Google Scholar 

  68. Babikian VL, Feldmann E, Wechsler LR, Newell DW, Gomez CR, Bogdahn U, et al. Transcranial Doppler ultrasonography: year 2000 update. J Neuroimag: Off J Am Soc Neuroimag. 2000;10(2):101–15.

    Article  CAS  Google Scholar 

  69. Brasil S, Bor-Seng-Shu E, de-Lima-Oliveira M, Taccone FS, Gattás G, Nunes DM, et al. Computed tomography angiography accuracy in brain death diagnosis. J Neurosurg. 2019:1–9.

    Google Scholar 

  70. Ducrocq X, Braun M, Debouverie M, Junges C, Hummer M, Vespignani H. Brain death and transcranial Doppler: experience in 130 cases of brain dead patients. J Neurol Sci. 1998;160(1):41–6.

    Article  CAS  PubMed  Google Scholar 

  71. Hadani M, Bruk B, Ram Z, Knoller N, Spiegelmann R, Segal E. Application of transcranial doppler ultrasonography for the diagnosis of brain death. Intensive Care Med. 1999;25(8):822–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurosonology and Cerebral Hemodynamic Laboratory, Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil

    Ricardo de Carvalho Nogueira, Rafaela Almeida Alquéres, Victor Marinho Silva & Pamela Torquato de Aquino

  2. Department of Neurology, Hospital Nove de Julho, São Paulo, Brazil

    Ricardo de Carvalho Nogueira

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  1. Ricardo de Carvalho Nogueira
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  2. Rafaela Almeida Alquéres
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  3. Victor Marinho Silva
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  4. Pamela Torquato de Aquino
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Editors and Affiliations

  1. University of São Paulo, São Paulo, Brazil

    Eberval Gadelha Figueiredo

  2. State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil

    Leonardo C. Welling

  3. University of Sao Paulo, São Paulo, São Paulo, Brazil

    Nícollas Nunes Rabelo

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de Carvalho Nogueira, R., Alquéres, R.A., Silva, V.M., de Aquino, P.T. (2021). Transcranial Doppler: Practical Applications. In: Figueiredo, E.G., Welling, L.C., Rabelo, N.N. (eds) Neurocritical Care for Neurosurgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-66572-2_9

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