Early changes in middle cerebral artery blood flow velocity after head injury.
OBJECTIVE
This study was designed to investigate the incidence of early abnormalities in the cerebral circulation after head injury by relating the results of the initial computerized tomography (CT) scan with transcranial Doppler (TCD) ultrasound readings to see if the side of injury and the outcome can be predicted by using these modalities.


METHODS
Transcranial Doppler ultrasound measurements were obtained in the emergency room in 22 head-injured patients less than 3 hours after injury. The middle cerebral artery (MCA) was insonated using a standard technique. The TCD measurements in each MCA were examined individually; of 39 measurements, 22 (56%) showed a low mean blood flow velocity, 27 (69%) demonstrated a high pulsatility index (PI), and 18 (46%) showed both abnormalities. The side of the cerebrovascular abnormality measured by TCD ultrasound did not appear to be an accurate predictor of the side of the injury as determined on the initial CT scan. Of 13 patients in whom either a space-occupying hematoma or signs of swelling were shown on the initial CT scan, 10 (77%) had an increased PI in one or both MCAs, which is an indication of high flow resistance.


CONCLUSIONS
Transcranial Doppler ultrasound examinations performed while patients are in the emergency room may have a role in determining treatment priorities, especially in those with multiple injuries.
Department of Neurosurgery, Royal London Hospital, United Kingdom.
J C
JC
McQuire
J C
JC
Sutcliffe
T J
TJ
Coats
D015998:Abbreviated Injury Scale; D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005544:Forecasting; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014655:Vascular Resistance / Q000502:physiology