Abstract
Introduction
In the catastrophic neurologic emergency, a complete neurological exam is not always
possible or feasible given the time-sensitive nature of the underlying disease process,
or if emergent airway management is indicated. As the neurologic exam may be limited
in some patients, the emergency physician is reliant on the assessment of brainstem
structures to determine neurological function. Physicians thus routinely depend on
advanced imaging modalities to further investigate for potential catastrophic diagnoses.
Acquiring these tests introduces the risks of transport as well as delays in managing
time-sensitive neurologic processes. A more immediate, non-invasive bedside approach
complementing these modalities has evolved: Transcranial Doppler (TCD).
Objective
This narrative review will provide a description of scenarios in which TCD may be
applicable. It will summarize the sonographic findings and associated underlying pathophysiology
in such neurocritical care patients. An illustrated tutorial, along with pearls and
pitfalls, is provided.
Discussion
Although there are numerous formalized TCD protocols utilizing four views (transtemporal,
submandibular, suboccipital, and transorbital), point-of-care TCD is best accomplished
through the transtemporal window. The core applications include the evaluation of
midline shift, vasospasm after subarachnoid hemorrhage, acute ischemic stroke, and
elevated intracranial pressure. An illustrative tutorial is provided.
Conclusions
With the wide dissemination of bedside ultrasound within the emergency department,
there is a unique opportunity for the emergency physician to utilize TCD for a variety
of conditions. While barriers to training exist, emergency physician performance of
limited point-of-care TCD is feasible and may provide rapid and reliable clinical
information with high temporal resolution.
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Article Info
Publication History
Published online: March 10, 2019
Accepted:
March 4,
2019
Received in revised form:
February 5,
2019
Received:
December 18,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
