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Assessment of Cerebral Perfusion Pressure by Transcranial Doppler in Pediatric Patients with Convulsive Status
Aritra Kapat1, Angana Bhattacharjee2, Kaushani Chatterjee1
1Department of Pediatric Medicine, Dr B C Roy Post Graduate Institute of Pediatric Sciences, 111, Narkeldanga Main Road, Kankurgachi, Phoolbagan, Kolkata, West Bengal, 700054, India.
Insights
Bedside transcranial Doppler (TCD) in children with convulsive status epilepticus (SE) can detect altered cerebral hemodynamics and perfusion pressure. This method aids in identifying risks of cerebral hypoperfusion shortly after seizure termination.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Cerebrovascular Physiology
Background:
- Convulsive status epilepticus (SE) in children can lead to significant neurological complications.
- Monitoring cerebral hemodynamics is crucial for managing SE and preventing secondary brain injury.
- Cerebral perfusion pressure (CPP) is a key indicator of adequate brain blood supply.
Purpose of the Study:
- To assess changes in cerebral hemodynamics and CPP in pediatric SE using bedside transcranial Doppler (TCD).
- To evaluate the utility of TCD in detecting potential cerebral hypoperfusion in SE patients.
Main Methods:
- Bedside TCD was performed on 42 children (1-12 years) with convulsive SE within 30 minutes of seizure termination.
- Measurements included mean flow velocity (Fvm), diastolic flow velocity (Fvd), and peak systolic velocity (PSV) in the middle cerebral arteries (MCA).
- Cerebral perfusion pressure (CPP) was calculated and compared to a control group of stable, non-neurological patients.
Main Results:
- Statistically significant alterations in Fvd, PSV, Fvm, and CPP were observed in the SE group compared to controls.
- Specific mean values for Fvd, PSV, Fvm, and CPP in the right and left MCA of SE patients were recorded.
Conclusions:
- Bedside TCD is effective in detecting alterations in cerebral flow velocities within 30 minutes of seizure termination in pediatric SE.
- These findings suggest TCD can identify children at risk of cerebral hypoperfusion following SE.
Objective:
To study the changes in cerebral hemodynamics and cerebral perfusion pressure (CPP) in children with convulsive status epilepticus (SE) by bedside transcranial doppler (TCD).
Methods:
Transcranial doppler of bilateral middle cerebral artery (MCA) was performed in 42 antiepileptic drug naïve convulsive SE patients (1-12 years) within 30 min of seizure termination and in 42 hemodynamically stable patients with non-neurological symptoms without any pre-existing cardiovascular and renal pathologies. The mean flow velocity (Fvm), diastolic flow velocity (Fvd) and peak systolic velocity (PSV) were measured, and CPP was calculated.
Results:
Mean (SD) Fvd, PSV, Fvm, and CPP in the right MCA in study group was 57.85 (3.57) cm/s, 139.90 (7.07) cm/s 85.19 (3.30) cm/s and 68.40 (4.91) mm Hg, respectively, and corresponding values in left MCA were 58.04 (3.35) cm/s, 139.90 (6.96) cm/s, 85.30 (3.20) cm/s, and 68.50 (4.93) mmHg. Alterations of Fvd, PSV, and Fvm and CPP were statistically significant in the study group compared to comparator group.
Conclusion:
Bedside TCD within 30 min of seizure termination in SE patients can detect alterations in cerebral flow velocities risking cerebral hypoperfusion.
