Transcranial Doppler study of intracranial circulatory arrest

To investigate the hemodynamics of intracranial circulatory arrest, the authors correlated the findings of noninvasive transcranial Doppler ultrasonography (TCD) with those of transfemoral four-vessel angiography in 65 patients following brain death and intracranial circulatory arrest due to severe intracranial hypertension. The three TCD stages of intracranial circulatory arrest, which have been described previously, corresponded with different levels of extracerebral angiographic cessation of flow. With TCD progression from the first stage (oscillating flow) to the third stage (no flow), the level where the dye stopped descended caudad from subarachnoid to cervical levels. The study shows that, in progressing intracranial hypertension, arterial circulatory standstill within the cranial cavity develops in a distal-to-proximal direction. The basal cerebral arteries remain patent in the early stages of intracranial circulatory arrest. Experimental evidence from the literature, together with the findings of the present investigation, points to the capillary bed as the initial site of the flow obstruction in progressing intracranial hypertension.