A. Razumovsky
Sentient NeuroCare Services, Inc. – Hunt Valley, USA

Critical care management of patients with traumatic brain injury (TBI) has undergone tremendous advances. Neurosurgeons, neurologists and neurointensivists, including military, have a large armamentarium of invasive monitoring modalities available to detect secondary brain injury and guide therapy. The primary goal monitoring is to prevent secondary insults to the brain, primarily cerebral ischemia due to the posttraumatic vasospasm (PTV), and intracranial hypertension (ICH). This lecture summarizes the advantages and the specific roles of transcranial Doppler (TCD) ultrasound to establish and monitor the presence of PTV and ICH.

Review of literature demonstrate that TCD is valid in predicting the patient's outcome of 6 months and correlates significantly with intracranial pressure when it is performed in the first 24 hours after event. Recently, there have been many research results in early judgment of PTV, and TCD studies are particularly prominent in this area. The prognosis is affected severely with regard to quality of life of patients, and earlier determination of the PTV becomes very important. TCD is non-invasive, fast, and reliable as an efficient ultrasound technology, especially in critically ill patients with PTV in an urgent examination. This means it that TCD has greater value and helps to improve the management of patients with TBI. Too often, the first sign is a neurologic deficit, which may be too late to reverse. However, use of TCD may predict PTV before clinical sequelae. TCD assists in the clinical decision-making regarding further diagnostic evaluation and therapeutic interventions and has become a regularly employed tool in neurocritical care. Accumulated today experience suggests that there is an important guiding significance in early diagnosis and treatment of PTV and ICH in TCD. Because PTV and ICH represent significant events in a high proportion of patients after wartime TBI, close daily TCD monitoring is recommended for the management of such patients.

Key words: intracranial hypertension, posttraumatic vasospasm, transcranial Doppler ultrasound, traumatic brain injury.

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