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Transcranial Doppler and brain death diagnosis
Critical Care Medicine
|July 1, 1994
Summary
Transcranial Doppler (TCD) monitoring in severe brain injury can detect changes in cerebral blood flow. Specific TCD waveforms correlate with brain death, suggesting its utility in diagnosis.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Diagnostic Imaging
Background:
- Severe intracranial disease poses challenges in monitoring patients.
- Assessing cerebral circulatory arrest and brain death requires reliable methods.
Purpose of the Study:
- To evaluate the clinical utility of transcranial Doppler (TCD) and continuous-wave Doppler (CWD) in monitoring patients with severe intracranial disease.
- To correlate hemodynamic phenomena with specific TCD/CWD waveforms during the progression to brain death.
Main Methods:
- Prospective, observational study in a medical intensive care unit.
- Thirty-seven consecutive patients with Glasgow Coma Scores < 7 were monitored.
- Transcranial Doppler examinations of middle cerebral arteries were performed four times daily.
Main Results:
- All patients showed high-resistance TCD waveforms with altered diastolic flow.
- Specific waveform patterns (diastolic reverse flow, brief systolic forward flow, undetectable flow) were observed in 22 brain-dead patients.
- These specific waveforms were not present in non-brain-dead comatose patients.
Conclusions:
- Transcranial Doppler is a noninvasive tool for documenting declining cerebral perfusion pressure.
- TCD may be integrated into future protocols for diagnosing brain death.