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Transcranial doppler children brain injury

Vinayak Narayan, Nasser Mohammed, Amey R Savardekar, Devi Prasad Patra, Christina Notarianni, Anil Nanda
BACKGROUND: Traumatic brain injury [TBI] is a leading cause of pediatric morbidity and mortality worldwide and intracranial pressure [ICP] monitoring plays a crucial role in its management. Based on existing literature, the authors review the current practicing non-invasive ICP monitoring devices and their accuracy in predicting raised ICP in pediatric TBI. MATERIALS AND METHODS: A thorough literature search was conducted on PubMed, Medline and Cochrane data base, articles were selected systematically, reviewed completely and relevant data was summarized and discussed...
March 7, 2018: World Neurosurgery
Karin Reuter-Rice
Transcranial Doppler ultrasound (TCD) is an inexpensive portable diagnostic tool commonly available within most healthcare systems. A team of trained individuals perform and interpret the test to inform patient care management. The benefit of TCD is well established in adult patients with traumatic brain injury. However, in children with TBI, it is still considered exploratory and its use is not a part of the standard of care. This article describes what TCD is, its use in children, and how TCD measurements apply to children and adolescents in an effort to establish criteria for the use of TCD for children with TBI...
March 2017: Journal of Radiology Nursing
Sylvie Chevret, Suzanne Verlhac, Elisabeth Ducros-Miralles, Jean-Hugues Dalle, Regis Peffault de Latour, Mariane de Montalembert, Malika Benkerrou, Corinne Pondarré, Isabelle Thuret, Corinne Guitton, Emmanuelle Lesprit, Maryse Etienne-Julan, Gisèle Elana, Jean-Pierre Vannier, Patrick Lutz, Bénédicte Neven, Claire Galambrun, Catherine Paillard, Camille Runel, Charlotte Jubert, Cécile Arnaud, Annie Kamdem, Valentine Brousse, Florence Missud, Marie Petras, Lydia Doumdo-Divialle, Claire Berger, Françoise Fréard, Olivier Taieb, Elise Drain, Monique Elmaleh, Manuela Vasile, Yacine Khelif, Myriam Bernaudin, Philippe Chadebech, France Pirenne, Gérard Socié, Françoise Bernaudin
BACKGROUND: Children with sickle cell anemia (SCA) have an 11% risk of stroke by the age of 18. Chronic transfusion applied in patients detected to be at risk by transcranial Doppler allows a significant reduction of stroke risk. However, chronic transfusion exposes to several adverse events, including alloimmunization and iron overload, and is not curative. Hematopoietic stem cell transplantation allows termination of the transfusion program, but its benefit has not been demonstrated...
November 2017: Contemporary Clinical Trials
Jay F Rilinger, Craig M Smith, Raye Ann O deRegnier, Joshua L Goldstein, Michele G Mills, Marleta Reynolds, Carl L Backer, Delilah M Burrowes, Priya Mehta, Juan Piantino, Mark S Wainwright
BACKGROUND: We used transcranial Doppler to examine changes in cerebral blood flow velocity in children treated with extracorporeal membrane oxygenation. We examined the association between those changes and radiologic, electroencephalographic, and clinical evidence of neurologic injury. METHODS: This was a retrospective review and prospective observational study of patients 18 years old and younger at a single university children's hospital. Transcranial Doppler studies were obtained every other day during the first 7 days of extracorporeal membrane oxygenation, and 1 additional study following decannulation, in conjunction with serial neurologic examinations, brain imaging, and 6- to 12-month follow-up...
October 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Kerri L LaRovere, Kush Kapur, Doff B McElhinney, Alexander Razumovsky, Barry D Kussman
BACKGROUND AND PURPOSE: Cerebral emboli are one potential cause of acute brain injury in children with congenital heart disease (CHD) undergoing cardiac catheterization. In this pilot study using transcranial Doppler (TCD) ultrasonography, we sought to evaluate the incidence, burden, and circumstances of cerebral high-intensity transient signals (HITS), presumably representing emboli, during pediatric cardiac catheterization. METHODS: Emboli monitoring of the right middle cerebral artery was performed in five children...
January 31, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Antonello D'Andrea, Marianna Conte, Massimo Cavallaro, Raffaella Scarafile, Lucia Riegler, Rosangela Cocchia, Enrica Pezzullo, Andreina Carbone, Francesco Natale, Giuseppe Santoro, Pio Caso, Maria Giovanna Russo, Eduardo Bossone, Raffaele Calabrò
Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler (TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency (≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old...
July 26, 2016: World Journal of Cardiology
Lori E Crosby, Naomi E Joffe, Blair Davis, Charles T Quinn, Lisa Shook, Darice Morgan, Kenya Simmons, Karen A Kalinyak
Stroke, a devastating complication of sickle cell anemia (SCA), can cause irreversible brain injury with physical and cognitive deficits. Transcranial Doppler ultrasonography (TCD) is a non-invasive tool for identifying children with SCA at highest risk of stroke. National guidelines recommend that TCD screening begin at age 2 years, yet there is research to suggest less than half of young children undergo screening. The purpose of this project was to use quality improvement methods to improve the proportion of patients aged 24-27 months who successfully completed their initial TCD from 25% to 75% by December 31, 2013...
July 2016: American Journal of Preventive Medicine
Tensing Maa, Keith Owen Yeates, Melissa Moore-Clingenpeel, Nicole F O'Brien
OBJECTIVE The objective of this study is to assess carbon dioxide reactivity (CO2R) in children following traumatic brain injury (TBI). METHODS This prospective observational study enrolled children younger than 18 years old following moderate and severe TBI. Thirty-eight mechanically ventilated children had daily CO2R testing performed by measuring changes in their bilateral middle cerebral artery flow velocities using transcranial Doppler ultrasonography (TCD) after a transient increase in minute ventilation...
July 2016: Journal of Neurosurgery. Pediatrics
Kerri L LaRovere, Nicole F O'Brien, Robert C Tasker
The purpose of this study was to identify and review clinical studies using transcranial Doppler (TCD) ultrasonography in children with severe traumatic brain injury (TBI) in the pediatric intensive care unit (PICU). We identified 16 articles from January 2005 to July 2015 that met inclusion (TBI, five or more cases in case series, subjects <18 years old, TCD performed in PICU) and exclusion criteria (age not stated, data from subjects <18 years not separated from adult data, <85% study population <18 years in mixed population with adults)...
December 1, 2016: Journal of Neurotrauma
Kerri L LaRovere, Nicole F O'Brien
Transcranial Doppler sonography is a noninvasive, real-time physiologic monitor that can detect altered cerebral hemodynamics during catastrophic brain injury. Recent data suggest that transcranial Doppler sonography may provide important information about cerebrovascular hemodynamics in children with traumatic brain injury, intracranial hypertension, vasospasm, stroke, cerebrovascular disorders, central nervous system infections, and brain death. Information derived from transcranial Doppler sonography in these disorders may elucidate underlying pathophysiologic characteristics, predict outcomes, monitor responses to treatment, and prompt a change in management...
December 2015: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Nicole F O'Brien, Tensing Maa, Karin Reuter-Rice
OBJECT: The aim of this study was to determine the relationship between transcranial Doppler (TCD) derived pulsatility index (PI), end diastolic flow velocity (Vd), and intracranial pressure (ICP). The subjects in this study were 36 children admitted after severe traumatic brain injury (TBI) (postresuscitation Glasgow Coma Scale ≤ 8) undergoing invasive ICP monitoring. METHODS: Subjects underwent a total of 148 TCD studies. TCD measurements of systolic flow velocity (Vs), Vd, and mean flow velocity (Vm) were performed on the middle cerebral artery (MCA) ipsilateral to the ICP monitor...
October 2015: Journal of Neurosurgery. Pediatrics
Nicole F O'Brien, Tensing Maa, Keith O Yeates
OBJECTIVE: To gain a description of the prevalence and time course of vasospasm in children suffering moderate-to-severe traumatic brain injury. DESIGN: A prospective, observational study was performed. Children with a diagnosis of traumatic brain injury, a Glasgow Coma Score less than or equal to 12, and abnormal head imaging were enrolled. Transcranial Doppler ultrasound was performed to identify and follow vasospasm. Diagnostic criteria included flow velocity elevation more than or equal to 2 sd above age and gender normal values for the middle cerebral and basilar arteries...
March 2015: Critical Care Medicine
Eboni I Lance, James F Casella, Allen D Everett, Emily Barron-Casella
Biomarker analysis and proteomic discovery in pediatric sickle cell disease has the potential to lead to important discoveries and improve care. The aim of this review article is to describe proteomic and biomarker articles involving neurological and developmental complications in this population. A systematic review was conducted to identify relevant research publications. Articles were selected for children under the age of 21 years with the most common subtypes of sickle cell disease. Included articles focused on growth factors (platelet-derived growth factor), intra and extracellular brain proteins (glial fibrillary acidic protein, brain-derived neurotrophic factor), and inflammatory and coagulation markers (interleukin-1β, l-selectin, thrombospondin-1, erythrocyte, and platelet-derived microparticles)...
December 2014: Proteomics. Clinical Applications
Kathleen J Helton, Robert J Adams, Karen L Kesler, Alex Lockhart, Banu Aygun, Catherine Driscoll, Matthew M Heeney, Sherron M Jackson, Lakshmanan Krishnamurti, Scott T Miller, Sharada A Sarnaik, William H Schultz, Russell E Ware
The Stroke With Transfusions Changing to Hydroxyurea (SWiTCH) trial compared standard (transfusions/chelation) to alternative (hydroxyurea/phlebotomy) treatment to prevent recurrent stroke and manage iron overload in children chronically transfused over 7 years before enrollment. Standardized brain magnetic resonance imaging/magnetic resonance angiography (MRA) and transcranial Doppler (TCD) exams were performed at entry and exit, with a central blinded review. A novel MRA vasculopathy grading scale demonstrated frequent severe baseline left/right vessel stenosis (53%/41% ≥Grade 4); 31% had no vessel stenosis on either side...
August 7, 2014: Blood
Michal Arkuszewski, Jaroslaw Krejza, Rong Chen, Rebecca Ichord, Janet L Kwiatkowski, Michel Bilello, Robert Zimmerman, Kwaku Ohene-Frempong, Elias R Melhem
PURPOSE: Children with sickle cell anemia (SCA), who have mean blood flow velocities <170 cm/s in the terminal internal carotid (tICA) or middle cerebral (MCA) arteries on transcranial Doppler ultrasonography (TCD), are considered to be at low risk of stroke. The prevalence of intracranial stenosis, which raises the risk of stroke, is not known in these children. Here, we estimated the prevalence of stenosis and explored its association with silent cerebral infarcts determined based on Magnetic Resonance (MR) scans...
March 2014: Advances in Medical Sciences
M Arkuszewski, J Krejza, R Chen, E R Melhem
Sickle cell anemia (SCA) is a chronic illness associated with progressive deterioration in patients' quality of life. The major complications of SCA are cerebrovascular accidents (CVA) such as asymptomatic cerebral infarct or overt stroke. The risk of CVA may be related to chronic disturbances in cerebral blood flow (CBF), but the thresholds of "normal" steady-state CBF are not well established. The reference tolerance limits of CBF can be useful to estimate the risk of CVA in asymptomatic children with SCA, who are negative for hyperemia or evidence of arterial narrowing...
April 2013: Neuroradiology Journal
Nicole F O'Brien, Mark W Hall
OBJECTIVE: To determine how extracorporeal membrane oxygenation affects cerebral blood flow velocity and to determine whether specific changes in cerebral blood flow velocity may be associated with neurologic injury. DESIGN: Prospective, observational study. SETTING: PICU in a tertiary care academic center. PATIENTS: Children (age less than or equal to 18 yr) requiring extracorporeal membrane oxygenation support. INTERVENTIONS: None...
March 2013: Pediatric Critical Care Medicine
Charles T Quinn, Michael M Dowling
BACKGROUND: Desaturation of hemoglobin (Hb) in cerebral tissue, a physiologic marker of brain vulnerable to ischemic injury, can be detected non-invasively by transcranial oximetry. Absolute cerebral oximetry has not been studied in sickle cell disease (SCD), a group at very high risk of cerebral infarction in whom prevention of brain injury is key. PROCEDURE: We measured absolute Hb saturation in cerebral tissue (S(CT)O(2)) in children with SCD using near-infrared spectrophotometry and investigated the contributions of peripheral Hb saturation (S(P)O(2)), hematologic measures, cerebral arterial blood flow velocity, and cerebral arterial stenosis to S(CT)O(2)...
November 2012: Pediatric Blood & Cancer
Samir H Haddad, Yaseen M Arabi
Traumatic brain injury (TBI) is a major medical and socio-economic problem, and is the leading cause of death in children and young adults. The critical care management of severe TBI is largely derived from the "Guidelines for the Management of Severe Traumatic Brain Injury" that have been published by the Brain Trauma Foundation. The main objectives are prevention and treatment of intracranial hypertension and secondary brain insults, preservation of cerebral perfusion pressure (CPP), and optimization of cerebral oxygenation...
February 3, 2012: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Lori C Jordan, James F Casella, Michael R DeBaun
This review will focus on the strengths and limitations associated with the current standard of care for primary prevention of ischaemic strokes in children with sickle cell anaemia (SCA) - transcranial Doppler ultrasound (TCD) screening followed by regular blood transfusion therapy when TCD measurement is above a threshold defined by a randomized clinical trial (RCT). The theoretical basis for potential alternative strategies for primary prevention of neurological injury in SCA is also discussed. These strategies will include, but will not be limited to: immunizations to prevent bacterial infections, particularly in low income countries; management of elevated blood pressure; and targeted strategies to increase baseline haemoglobin levels with therapies such as hyroxycarbamide or potentially definitive haematopoietic stem cell transplant...
April 2012: British Journal of Haematology
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