Trauma to the head, eye, or orbital structures Sonography of the eye has a wide array of applications in point-of-care ultrasonography indications for its use alone, distinct from the other elements of a transcranial Doppler exam, include 17: Sonographic examination of the orbit will also be discussed, as the measurement of the optic nerve sheath diameter (OSND) and spectral waveform analysis of the ophthalmic artery are essential parts of a complete transcranial Doppler examination. Suspicion for intraventricular hemorrhage Indications for transcranial Doppler more specific to pediatric age groups, especially pertaining to neonates, include:īoth scores, at one and five minutes, under 7 Intra/peri-operative evaluation of cerebral perfusionĬonfirmation of cerebral circulatory arrest General indications for the use of transcranial Doppler ultrasonography include:Ĭlinical suspicion of cerebral vasculopathyĮvaluation for complications of subarachnoid hemorrhage Neurosonography of the fetal brain, although based on similar principles, will not be discussed this article will focus on neonatal, pediatric, and adult indications for sonographic studies of the brain and cerebral vasculature, especially as it pertains to point-of-care ultrasound. "TCD" and "transcranial Doppler" will be used to refer to the combined 2D parenchymal imaging with or without the use of Doppler modalities.Īdvantages of TCD over its "conventional" predecessor include an ability to identify structural perturbations, including the presence of masses and/or midline shift, and the presence of sonoanatomical landmarks to guide placement of a pulsed wave Doppler gate 18. Some may refer to the imaging modality to be discussed below as transcranial color-coded duplex sonography (TCCS) and the non-imaging based continuous wave Doppler modality as transcranial Doppler (TCD) this article will not make this distinction, as the latter (non-imaging) modality will not be further discussed. Finally, we note the word “vasospasm” is missing an “s” in Fig. 1, but overall, we commend the authors for their nice summary of TCD use.An extension of the non-imaging, continuous wave Doppler assessment popular among neurointensivists, the imaging of cerebral structures with grey-scale and superimposed color flow and spectral Doppler analysis is now possible using the same windows, techniques, and diagnostic goals. The most common reason we see for lack of adoption of TCD in intensive care/NeuroICU practice is the lack of these 2 elements. In some cases, teleneurosonology can be performed assuming the 2 caveats above are in place. In our experience, TCD (both blind methods with Spencer ST3 machines, for example) and TCD-imaging methods are useful in the NeuroICU, with 2 major technical caveats: the need for (1) adequate ultrasonographic skills of acquiring imaging and (2) adequate training in interpretation of all features on TCD imaging, including the pulsatility index (i.e., Gosling) and resistance indices (e.g., Pourcelot). However, we find this ironic, since there is a rise in general critical care ultrasound given its noninvasive utility without ionizing radiation risk compared to computed tomography-based methods of diagnostic evaluation of chest and abdominal body cavities. We feel the authors’ work is important, especially at a time when TCD seems to be falling out of favor in some NeuroICUs and guidelines. We agree completely with the versatility of transcranial Doppler (TCD) ultrasound in the neurointensive care unit (NeuroICU) population and similarly employ it for its uses for aneurysmal subarachnoid hemorrhage, brain death, and circulatory arrest, and as a noninvasive surrogate for intracranial compliance and elastance. We read with great interest the article by Drs.
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