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[Diagnosis of brain stem ischemia by transcranial Doppler ultrasonography]
G Stepińska1, Z Czernicki, J Berdyga
1Kliniki Neurochirurgii ICMDiK PAN, Warszawie.
Insights
Elevated intracranial pressure in cats was studied using Transcranial Doppler (TCD). The basilar artery showed the earliest TCD changes, indicating brain stem ischemia during the Cushing response.
Area of Science:
- Neuroscience
- Cerebrovascular Physiology
- Medical Imaging
Context:
- Intracranial pressure (ICP) monitoring is crucial in neurocritical care.
- Transcranial Doppler (TCD) is a non-invasive tool for assessing cerebral blood flow.
- Understanding the cerebrovascular response to elevated ICP is vital for diagnosing and managing neurological emergencies.
Purpose:
- To investigate the utility of Transcranial Doppler (TCD) in detecting early signs of brain stem ischemia.
- To characterize the cerebrovascular changes in feline models with induced intracranial hypertension.
- To correlate TCD findings with the development of the Cushing response.
Summary:
- Intracranial pressure was elevated in cats via intrathecal infusions.
- Transcranial Doppler (TCD) monitored the middle cerebral artery and basilar artery during induced hypertension and subsequent Cushing response.
- The basilar artery exhibited the earliest TCD alterations, with increased pulsatility index and decreased diastolic velocity being the most diagnostic indicators of brain stem ischemia.
Impact:
- This study highlights the potential of TCD as an early diagnostic tool for brain stem ischemia in cases of elevated intracranial pressure.
- Findings provide valuable insights into the cerebrovascular dynamics during hypertensive crises.
- The identified TCD parameters may aid in the timely clinical management of patients with increased intracranial pressure.
Abstract:
Intracranial pressure (ICP) was elevated in cats by intrathecal infusions. Middle cerebral artery and basilar artery were studied using Transcranial Doppler (TCD) during the infusion followed by systemic arterial pressure increase (Cushing response). Cushing response was symptomatic for brain stem ischaemia. The earliest TCD changes concerned the basilar artery. The most informative data for the diagnosis were pulsatility index increase and diastolic velocity decrease.