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Transcranial Doppler Sonography for Detecting Stenosis or Occlusion of Intracranial Arteries in People with Acute Ischemic Stroke in Neurocritical Care Unit.

Introduction: A Transcranial Doppler (TCD) is an inexpensive noninvasive ultrasonography technique that helps provide a rapid real time measure of blood flow from the basal intracerebral vessels, which may be used for the diagnosis and follow-up of cerebrovascular disease. By placing the ultrasound probe on the scalp; it utilizes low frequency soundwaves to record cerebral blood flow velocity, and its change in multiple conditions. Technology offers several diagnostic tests available in the evaluation and treatment of cerebrovascular diseases (CVD). Transcranial ultrasonography may represent a valuable tool for patients with CVD in neurocritical care unit. However due to geographic, financial or patient tolerance of procedures, physicians may be limited to the tools they can utilize. 

Method: Diagnostic accuracy of transcranial ultrasonography in acute stroke was subjected to systematic review. This study will set to demonstrate that the Transcranial Doppler (TCD) ultrasound is a viable piece of technology, which overcomes barriers mentioned in both the diagnosis and treatment of CVD. Cerebral flow peak systolic velocity (CBFVs), mean flow velocity (CBFVm), and the end diastolic velocity CBFVd) values are three components, which characterize the spectral waveform derived from TCD. These flow velocities provide valuable physiologic perspectives in various intracranial pathologies. We have demonstrated TCD to be highly predictive of evidence of vasospasm in patients with an aneurysmal subarachnoid hemorrhage with a 95% confidence interval. In patients with traumatic brain injury, TCD has been shown to be effective with a 95% confidence interval in the assessment of intracranial pressure and cerebral flow velocity. For strokes, TCD was shown to be effective with an overall sensitivity of 83% for the diagnosis, prognosis and treatment of ischemic strokes. 

Results: Due to its portability, affordability, and noninvasive application along with the high confidence intervals seen in our study, our data suggests the successful application of TCD in various pathologies in both diagnosis and monitoring of patients with various CVD.