Accidental Hypothermia and Transcranial Doppler Sonography: Case Report

Area of Science:

• Neurology
• Emergency Medicine
• Critical Care

Background:

• Accidental hypothermia presents a significant challenge in emergency departments, often associated with altered neurological function.
• Cerebral perfusion monitoring is crucial for managing hypothermia patients, but traditional methods can be invasive or time-consuming.

Observation:

• A case of severe accidental hypothermia (25.6°C) in a 78-year-old male presenting with speech impairment is detailed.
• Bedside transcranial Doppler (TCD) was utilized to assess cerebral blood flow velocity in the middle cerebral artery.
• Serial TCD measurements demonstrated dynamic changes in end-diastolic velocity (EDV), peak systolic velocity (PSV), and pulsatile index (PI) correlating with rewarming and neurological recovery.

Findings:

• Initial TCD revealed low cerebral blood flow velocities (EDV: 13.42 cm/s, PSV: 40.25 cm/s) in the hypothermic state.
• As the patient's core temperature increased, TCD parameters significantly improved (EDV: 26.12 cm/s, PSV: 84.02 cm/s) within one hour.
• Complete normalization of TCD findings coincided with the patient's return to normothermia and full neurological recovery.

Implications:

• This report suggests bedside TCD is a valuable, non-invasive tool for real-time assessment of cerebral perfusion in accidental hypothermia patients.
• TCD monitoring can aid in guiding and evaluating the effectiveness of therapeutic interventions during emergency department care.
• Further research into TCD's role in hypothermia management may enhance patient outcomes and treatment strategies.