[Clinical use of transcranial Doppler in critical neurological patients. Results of a multicenter study].

BACKGROUND AND OBJECTIVE: We aimed to determine the clinical usefulness of transcranial Doppler (TCD) in critical neurological patients.

PATIENTS AND METHOD: 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.