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Crit Ultrasound J. 2017 Oct 13;9(1):21. doi: 10.1186/s13089-017-0077-9.

Point-of-care transcranial Doppler by intensivists.

Author information

1
Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. vinceissaclau@gmail.com.
2
London Health Sciences Centre, Victoria Hospital Rm, D2-528, 800 Commissioners Road East, London, ON, N6A 5W9, Canada. vinceissaclau@gmail.com.
3
Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
4
London Health Sciences Centre, Victoria Hospital Rm, D2-528, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.

Abstract

In the unconscious patient, there is a diagnostic void between the neurologic physical exam, and more invasive, costly and potentially harmful investigations. Transcranial color-coded sonography and two-dimensional transcranial Doppler imaging of the brain have the potential to be a middle ground to bridge this gap for certain diagnoses. With the increasing availability of point-of-care ultrasound devices, coupled with the need for rapid diagnosis of deteriorating neurologic patients, intensivists may be trained to perform point-of-care transcranial Doppler at the bedside. The feasibility and value of this technique in the intensive care unit to help rule-in specific intra-cranial pathologies will form the focus of this article. The proposed scope for point-of-care transcranial Doppler for the intensivist will be put forth and illustrated using four representative cases: presence of midline shift, vasospasm, raised intra-cranial pressure, and progression of cerebral circulatory arrest. We will review the technical details, including methods of image acquisition and interpretation. Common pitfalls and limitations of point-of-care transcranial Doppler will also be reviewed, as they must be understood for accurate diagnoses during interpretation, as well as the drawbacks and inadequacies of the modality in general.

KEYWORDS:

Cerebral circulatory arrest; Intra-cranial pressure; Midline shift; Neuro-critical care; Point-of-care ultrasound; Vasospasm

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