[Clinical use of transcranial Doppler in critical neurological patients. Results of a multicenter study].
OBJECTIVE
We aimed to determine the clinical usefulness of transcranial Doppler (TCD) in critical neurological patients.


METHODS
Prospective, multicenter study of 66 patients (44 men) with acute neurologic disorders (16 brain injury, 25 subarachnoid hemorrhage, 15 intracerebral hemorrhage, 2 ischemic stroke, 2 metabolic encephalopaty, 5 brain ischemia after cardiac arrest, and another pathology), admitted to 7 intensive care units. Data collection was performed during one month from 8 AM to 5 PM. An ultrasonographic study was performed in every patient every day; 234 studies were performed with 227 medium cerebral artery (MCA) blood flow determinations. Several patterns of cerebral blood flow were established: normal, hyperhemia, vasospasm, intracranial hypertension and brain death.


RESULTS
Intracranial hypertension was found during 109 determinations (48%), a normal pattern was found in 104 (45.5%), hyperhemia in 9 (4%) and brain death in 5 (2.2%) patients. Doppler determinations meant that, in 195 cases (86%) no change in the clinical, diagnostic or therapeutic approach was necessary, in 18 cases (8%) medical treatment was changed, in 8 cases (3.5%) it was suggested to perform a CT scan and in 2 cases (0.9%) it was suggested to perform an EEG. Moreover, an intracranial pressure monitoring was indicated after one Doppler determination (0.4%) and in 3 cases (1.3%) a brain death diagnosis was done.


CONCLUSIONS
The use of transcranial Doppler in critical neurological patients modified the management in 36% of them.
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial