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Transcranial Doppler ultrasound in neurocritical care

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Abstract

Multimodality monitoring is a common practice in caring for neurocritically ill patients, and consists mainly in clinical assessment, intracranial pressure monitoring and using several imaging methods. Of these imaging methods, transcranial Doppler (TCD) is an interesting tool that provides a non-invasive, portable and radiation-free way to assess cerebral circulation and diagnose and follow-up (duplex method) intracranial mass-occupying lesions, such as hematomas and midline shift. This article reviews the basics of TCD applied to neurocritical care patients, offering a rationale for its use as well as tips for practitioners.

Sommario

Il monitoraggio multimodale è una pratica comune nella cura dei pazienti neurocritici consistente principalmente nella valutazione clinica, nel monitoraggio della pressione intracranica e nell’utilizzo di varie tecniche di immagine. Tra queste ultime il Doppler Transcranico (DTC), è certamente importante essendo una metodica non invasiva, portatile e non soggetta all’utilizzo di radiazioni ionizzanti per la valutazione della circolazione cerebrale e per la diagnosi e il monitoraggio di lesioni occupanti spazio come gli ematomi e di deviazione della linea mediana. In questo lavoro sono riassunti i principi di base del DTC applicato ai pazienti neurocritici, viene analizzato il razionale di utilizzo della metodica e sono forniti suggerimenti pratici per l’esecuzione dell’esame.

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Abbreviations

ICP:

Intracranial pressure

TCD:

Transcranial Doppler

TCCS:

Transcranial color-coded duplex sonography

POCUS:

Point-of-care ultrasound

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

ACA:

Anterior cerebral artery

VA:

Vertebral artery

BA:

Basilar artery

SV:

Peak systolic velocity

DV:

End-diastolic velocity

MV:

Mean velocity

PI:

Pulsatility index

RI:

Resistive index

CBF:

Cerebral blood flow

OA:

Ophthalmic artery

LI:

Lindegaard index

ECA:

External carotid artery

ONSD:

Optic nerve sheath diameter

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Acknowledgments

The authors would like to thank Mrs. Gladys Lo Ponte (Nurse, Old people´s Home “Dr. Alejandro Raimondi”, Necochea, Argentina) for her valuable help in editing the Italian version of the abstract.

Funding

This work has not been supported by any grants.

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Authors and Affiliations

  1. Ecodiagnóstico-Centro de Diagnóstico por Imágenes, 3272, 50 St., 7630, Necochea, Argentina

    Pablo Blanco

  2. Centro de Investigaciones Médico-Quirúrgicas, 11-13 and 216 St., Siboney, 12100, Havana, Cuba

    Anselmo Abdo-Cuza

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  1. Pablo Blanco
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Correspondence to Pablo Blanco.

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All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinski declaration and its later amendments or comparable ethical standards.

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Blanco, P., Abdo-Cuza, A. Transcranial Doppler ultrasound in neurocritical care. J Ultrasound 21, 1–16 (2018). https://doi.org/10.1007/s40477-018-0282-9

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