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Transcranial Doppler study of intracranial circulatory arrest
W Hassler1, H Steinmetz, J Pirschel
1Department of Neurosurgery, University of Tübingen, West Germany.
Insights
Transcranial Doppler ultrasonography (TCD) stages correlate with angiography findings in intracranial circulatory arrest. This study reveals circulatory standstill progresses distally to proximally, originating in the capillary bed during intracranial hypertension.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Intracranial circulatory arrest is a critical complication of severe intracranial hypertension.
- Understanding the hemodynamics of this process is crucial for diagnosis and management.
- Noninvasive methods for assessing cerebral blood flow cessation are highly desirable.
Purpose of the Study:
- To correlate noninvasive transcranial Doppler ultrasonography (TCD) findings with transfemoral four-vessel angiography in patients with intracranial circulatory arrest.
- To elucidate the hemodynamic progression of intracranial circulatory arrest.
- To identify the initial site of flow obstruction in intracranial hypertension.
Main Methods:
- Correlation of TCD stages with transfemoral four-vessel angiography findings.
- Analysis of 65 patients with brain death and intracranial circulatory arrest.
- Assessment of TCD progression from oscillating flow to no flow.
Main Results:
- Three TCD stages of intracranial circulatory arrest corresponded to different levels of angiographic flow cessation.
- As TCD stages progressed, the level of dye cessation descended from subarachnoid to cervical levels.
- Arterial circulatory standstill occurs in a distal-to-proximal direction within the cranial cavity.
- Basal cerebral arteries remained patent in early stages of circulatory arrest.
Conclusions:
- TCD is a valuable tool for assessing intracranial circulatory arrest hemodynamics.
- Intracranial hypertension leads to circulatory standstill originating in the capillary bed and progressing proximally.
- Cerebral blood flow cessation follows a predictable pattern during intracranial hypertension.
Abstract:
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.