scholarly journals Transcranial doppler in patients with ruptured brain aneurysms in cerebral hemodynamics evaluation and outcomes predicting

2019 ◽  
pp. 127-136
Author(s):  
L. T. Khamidova ◽  
V. V. Krylov ◽  
S. S. Petrikov ◽  
N. V. Rybalko
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Cerebral Aneurysm ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Pulsatility Index ◽  
Cerebral Hemodynamics ◽  
Arterial Aneurysm ◽  
Excellent Outcome ◽  
Acceptable Outcome

The purpose: to develop Doppler criteria in the evaluation of cerebral hemodynamics in predicting the outcome of the disease in patients with cerebral aneurysm rupture.Materials and methods. 172 patients (76 male, 96 female) with cerebral aneurism rupture were participated in the research. All patients were continuously monitored by Doppler studies (a total of 803 studies) in the period from 1 to 20 days after the rupture of the arterial aneurysm. TCD was performed on the apparatus DWL MULTI-DOP T (Germany) with sensors 2 and 4 MHz. All patients were divided into 5 groups depending on the Glasgow outcome Scale (GOS) assessment. Group 1 (n = 87; 50.6%): with an excellent outcome of the disease (GOS 1); group 2 (n = 27; 15.7%): with an good outcome of the disease (GOS 2); group 3 (n = 8; 4.65%): with an acceptable outcome of the disease (GOS 3); group 4 (n = 6; 3.48%): with an acceptable outcome of the disease (GOS 4); group 5 (n = 8; 4.65%): with a lethal outcome of the disease (GOS 5) Systolic blood flow velocity (BFV), Lindegaard index and pulsatility index were estimatedResults. Doppler prognostic criterion of disease outcome were developed: early and progressive increase in blood flow velocity (development of spasm on the 1 day delay after hemorrhage); the development of critical spasm (blood flow velocity over 300 cm/s) by 7–8 days after subarachnoid hemorrhage, the rise of the blood flow velocity per day more than 36 cm/s; the duration of the spasm more than 16 days; increase in pulsatility index (more than 1.0) and Lindegaard index (more than 4.8), the presence of diffuse spasm.Conclusion. The transcranial Doppler can be an additional screening non-invasive diagnostic method for cerebral hemodynamic evaluation and for determination complications in ruptured cerebral aneurysm.

Transcranial Doppler Pulsatility Index: Not an Accurate Method to Assess Intracranial Pressure

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1050-1057 ◽  
Author(s):  
Anders Behrens ◽  
Niklas Lenfeldt ◽  
Khalid Ambarki ◽  
Jan Malm ◽  
Anders Eklund ◽  
...  
Keyword(s):  
Blood Flow ◽  
Intracranial Pressure ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Pulsatility Index ◽  
Transcranial Doppler Sonography ◽  
Accurate Method ◽  
Mathematical Simulations

Abstract BACKGROUND Transcranial Doppler sonography (TCD) assessment of intracranial blood flow velocity has been suggested to accurately determine intracranial pressure (ICP). OBJECTIVE We attempted to validate this method in patients with communicating cerebrospinal fluid systems using predetermined pressure levels. METHODS Ten patients underwent a lumbar infusion test, applying 4 to 5 preset ICP levels. On each level, the pulsatility index (PI) in the middle cerebral artery was determined by measuring the blood flow velocity using TCD. ICP was simultaneously measured with an intraparenchymal sensor. ICP and PI were compared using correlation analysis. For further understanding of the ICP-PI relationship, a mathematical model of the intracranial dynamics was simulated using a computer. RESULTS The ICP-PI regression equation was based on data from 8 patients. For 2 patients, no audible Doppler signal was obtained. The equation was ICP = 23*PI + 14 (R2 = 0.22, P < .01, N = 35). The 95% confidence interval for a mean ICP of 20 mm Hg was −3.8 to 43.8 mm Hg. Individually, the regression coefficients varied from 42 to 90 and the offsets from −32 to +3. The mathematical simulations suggest that variations in vessel compliance, autoregulation, and arterial pressure have a serious effect on the ICP-PI relationship. CONCLUSIONS The in vivo results show that PI is not a reliable predictor of ICP. Mathematical simulations indicate that this is caused by variations in physiological parameters.

scholarly journals Psychopathological Symptom Load and Distinguishable Cerebral Blood Flow Velocity Patterns in Patients With Schizophrenia and Healthy Controls: A Functional Transcranial Doppler Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Stephan T. Egger ◽  
Julio Bobes ◽  
Katrin Rauen ◽  
Erich Seifritz ◽  
Stefan Vetter ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Velocity ◽  
Processing Speed ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Cerebral Hemodynamics ◽  
Healthy Controls ◽  
Neurocognitive Deficits ◽  
Psychopathological Symptom ◽  
Symptom Load

Introduction: Schizophrenia is a severe psychiatric disorder, with executive dysfunction and impaired processing speed playing a pivotal role in the course of the disease. In patients with schizophrenia, neurocognitive deficits appear to be related to alterations in cerebral hemodynamics. It is not fully understood if psychopathological symptom load (i.e., presence and severity of symptoms) is also related to alterations in cerebral hemodynamics. We aim to study the relationship between psychopathological symptom load and cerebral hemodynamics in the Middle Cerebral Artery (MCA) during a cognitive task in patients with schizophrenia and healthy controls.Methodology: Cerebral hemodynamics in the MCA were examined in 30 patients with schizophrenia and 15 healthy controls using functional Transcranial Doppler (fTCD) during the Trail Making Test (TMT). Psychopathological symptoms were measured using the Brief Psychiatric Rating Scale (BPRS). Patients were dichotomized according to BPRS scores: mild-moderate (BPRS < 41, n = 15) or marked-severe (BPRS ≧ 41, n = 15). Mean blood flow velocity (MFV) in the MCA and processing speed of the TMT were analyzed. Cerebral hemodynamics were analyzed using the general additional model (GAM) with a covariate analysis of variance (ANCOVA) for group comparisons.Results: Patients and healthy controls were comparable regarding demographics. Patients had a slower processing speed for the TMT-A (patients-severe: 52s, patients-moderate: 40s, healthy-controls: 32s, p = 0.019) and TMT-B [patients-severe: 111s, patients-moderate: 76s, healthy-controls: 66s, p < 0.001)]. Patients demonstrated differing hemodynamic profiles in both TMTs: TMT- A [F(6, 1,792) = 17, p < 0.000); TMT-B [F(6, 2,692) = 61.93, p < 0.000], with a delay in increase in MFV and a failure to return to baseline values.Conclusions: Patients with schizophrenia demonstrated slower speeds of processing during both the TMT-A and TMT-B. The speed of processing deteriorated with increasing psychopathological symptom load, additionally a distinct cerebral hemodynamic pattern in the MCA was observed. Our results further support the view that severity of schizophrenia, particularly psychopathological symptom load, influences performance in neurocognitive tasks and is related to distinct patterns of brain hemodynamics.

scholarly journals Transcranial Doppler ultrasonography (uses, limitations, and potentials): a review article

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Mohammed F.A Ali
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Pulsatility Index ◽  
Doppler Ultrasonography ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Vessels ◽  
Transcranial Doppler Ultrasonography

Abstract Background The additional information that transcranial Doppler can provide as part of a multimodal imaging protocol in many clinical settings has not been evaluated. Main body Transcranial Doppler is a bedside procedure used to assess cerebral blood flow velocity via cerebral circulation and pulsatility index (PI). Many diseases can lead to cerebral vessels vasospasm as in subarachnoid hemorrhage and trauma. Cerebral vessels vasospasm represented by abnormal elevation of cerebral blood flow velocity. Intracranial pressure can be monitored by pulsatility index which reflects blood flow resistance in cerebral vessels. Transcranial Doppler ultrasonography is also the unique modality for detection of micro emboli in high-risk patients. Also, it can be used for evaluation of circulatory arrest with subsequent confirmation of brain death Conclusion Transcranial Doppler ultrasonography is the only diagnostic modality that provides a reliable assessment of cerebral blood flow patterns in real time. The physiological information obtained from TCD is complementary to the anatomical details obtained from other neuroimaging modalities. TCD is relatively cheap, can be performed bedside, and allows monitoring in acute emergency settings.

scholarly journals Association of transcranial Doppler blood flow velocity slow waves with delayed cerebral ischemia in patients suffering from subarachnoid hemorrhage: a retrospective study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Vasilios E. Papaioannou ◽  
Karol P. Budohoski ◽  
Michal M. Placek ◽  
Zofia Czosnyka ◽  
Peter Smielewski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Flow Velocity ◽  
Transcranial Doppler ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Delayed Cerebral Ischemia ◽  
Area Under The Curve ◽  
Slow Waves

Abstract Background Cerebral vasospasm (VS) and delayed cerebral ischemia (DCI) constitute major complications following subarachnoid hemorrhage (SAH). A few studies have examined the relationship between different indices of cerebrovascular dynamics with the occurrence of VS. However, their potential association with the development of DCI remains elusive. In this study, we investigated the pattern of changes of different transcranial Doppler (TCD)-derived indices of cerebrovascular dynamics during vasospasm in patients suffering from subarachnoid hemorrhage, dichotomized by the presence of delayed cerebral ischemia. Methods A retrospective analysis was performed using recordings from 32 SAH patients, diagnosed with VS. Patients were divided in two groups, depending on development of DCI. Magnitude of slow waves (SWs) of cerebral blood flow velocity (CBFV) was measured. Cerebral autoregulation was estimated using the moving correlation coefficient Mxa. Cerebral arterial time constant (tau) was expressed as the product of resistance and compliance. Complexity of CBFV was estimated through measurement of sample entropy (SampEn). Results In the whole population (N = 32), magnitude of SWs of ipsilateral to VS side CBFV was higher during vasospasm (4.15 ± 1.55 vs before: 2.86 ± 1.21 cm/s, p < 0.001). Ipsilateral SWs of CBFV before VS had higher magnitude in DCI group (N = 19, p < 0.001) and were strongly predictive of DCI, with area under the curve (AUC) = 0.745 (p = 0.02). Vasospasm caused a non-significant shortening of ipsilateral values of tau and increase in SampEn in all patients related to pre-VS measurements, as well as an insignificant increase of Mxa in DCI related to non-DCI group (N = 13). Conclusions In patients suffering from subarachnoid hemorrhage, TCD-detected VS was associated with higher ipsilateral CBFV SWs, related to pre-VS measurements. Higher CBFV SWs before VS were significantly predictive of delayed cerebral ischemia.

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