Acute increase in intracranial pressure revealed by transcranial Doppler sonography.
Increased pulsatility of blood flow in the basal cerebral arteries recorded with the use of transcranial Doppler sonography (TCD) corresponds to increased intracranial pressure (ICP) to near the level of the diastolic arterial blood pressure. We describe the case of a 39-year-old woman who developed acute reduction in consciousness, anisocoria, gaze deviation, and right-sided hemiparesis 2 days after resection of a relapsed astrocytoma. MRI revealed only a moderate enlargement of the ventricles, but TCD revealed highly pulsatile waveforms of all basal cerebral arteries, showing a biphasic pattern with diastolic backflow. This pattern was interpreted as a massive increase in ICP with imminent danger of cerebral circulatory arrest corresponding to acute malresorptive hydrocephalus. External cerebrospinal fluid drainage was immediately undertaken, revealing excessive ICP of more than 50 cm H(2)O. Twenty-four hours after this intervention, both the ICP and the Doppler waveforms had returned to normal. This case illustrates the usefulness of TCD for diagnosing a critical but potentially reversible acute increase in ICP with imminent cerebral circulatory arrest.
Reinhard
Matthias
M
Department of Neurology and Clinical Neurophysiology, Neurocenter, University of Freiburg, Breisacherstrasse 64, D-79106 Freiburg, Germany.
Petrick
Manfred
M
Steinfurth
Georg
G
Ziyeh
Sargon
S
Hetzel
Andreas
A
D000208:Acute Disease; D001254:Astrocytoma / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging* / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D011673:Pulsatile Flow; D017585:Ultrasonography, Doppler, Transcranial