Transcranial colour-coded sonography for the bedside evaluation of mass effect after stroke

Area of Science:

• Neurology
• Medical Imaging
• Ultrasound Technology

Background:

• Cranial computerized tomography (CT) scans for elevated intracranial pressure are time-consuming and require patient transport.
• Assessing mass effect from ischemic stroke or brain hemorrhage is crucial for patient management.
• Bedside diagnostic tools are needed to streamline monitoring in critical care and stroke units.

Purpose of the Study:

• To evaluate the diagnostic value of transcranial duplex sonography (TDS) as a bedside tool.
• To detect mass effect in space-occupying ischemic stroke and brain hemorrhage.
• To assess ventricular system width and midline structure dislocation.

Main Methods:

• Prospective evaluation of 21 consecutive patients with space-occupying ischemic stroke or brain hemorrhage.
• TDS examinations performed within 2 hours of corresponding follow-up CT scans.
• Measured third ventricular width for infratentorial and midline shift for supratentorial mass effect.

Main Results:

• TDS identified midline structures in all patients.
• Significant third ventricular dilation correlated with infratentorial mass effect.
• Midline shift occurred in all supratentorial lesions.
• Mean differences from CT were 0.8 mm for ventricular width and 1.1 mm for midline shift (R=0.97 and R=0.94).

Conclusions:

• TDS is a reliable bedside method for evaluating third ventricular width and lateral displacement.
• TDS is validated against CT scans for assessing space-occupying effects.
• TDS is suitable for monitoring supratentorial and infratentorial strokes in critical care settings.