title: Cerebral pulsatility index by transcranial Doppler sonography predicts the prognosis of patients with fulminant hepatic failure.
abstract: OBJECTIVE
  Cerebral hemodynamic derangement is well known in patients with fulminant hepatic failure. The advent of transcranial Doppler sonography (TCD) enabled noninvasive observation of cerebral hemodynamics. To evaluate its clinical usefulness, we examined longitudinal cerebral hemodynamic parameters in patients with fulminant hepatic failure and severe acute hepatitis.
  
  
  METHODS
  The six subjects were four patients with fulminant hepatic failure, one with severe acute hepatitis and one with severe acute exacerbation on chronic hepatitis. The pulsatility indices of the right middle cerebral artery were used as parameters of cerebral hemodynamics.
  
  
  RESULTS
  The pulsatility indices of the two patients with a deteriorating course had elevated to >1.00, whereas those of the two patients undergoing recovery were within normal limits, as well as of the patients with acute hepatitis or acute exacerbation on chronic hepatitis.
  
  
  CONCLUSIONS
  Cerebral pulsatility measured by TCD may be a real-time and useful tool to assess and monitor patients with fulminant hepatic failure.
authors.affiliation: Second Department of Internal Medicine, Faculty of Medicine, Tottori University School of Medicine, Nishimachi, Yonago, Japan.
authors.forename: Manri
authors.initials: M
authors.lastname: Kawakami
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koda
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Murawaki
mesh_terms: D000328:Adult; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006439:Hemodynamics; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D011673:Pulsatile Flow; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D055815:Young Adult