Transcranial Doppler in Patients with Severe Traumatic Brain Injury: A Cross-Sectional Study
Muhammad Khan, Sajida Ghilzai, Abdul Waheed, Allah Rasan4, Nasrullah, Farzana Rahim
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ABSTRACT
Aim: To assess the role of transcranial Doppler in
patients with severe traumatic brain injury
Study
design:
A cross-sectional study
Place
and duration:
This study was conducted at Mekran Medical college Turbat Pakistan.
Methodology:
Transcranial
Doppler (TCD) was performed on 255
patients with severe traumatic brain injury (TBI) who had a Glasgow Coma Scale
of 8 or less on admission. All the
patients were on a ventilator. TCD was performed on the first, second, third,
and seventh days of the hospital stay. Two out of three of the following were
used to define hypoperfusion: 1. A
mean velocity of less than 35 cm/sec in the middle cerebral artery 2. The
diastolic velocity of the middle cerebral artery is seen to be lesser than 20
cm/sec and 3. A pulsatility index of more than 1.4 was recorded.
The following criteria were used to identify
vasospasm: mean velocity of the middle cerebral artery more than 120 cm/sec
and Landegaarde index greater than 3. The Lindegaard index is the ratio of
middle cerebral artery blood flow to internal carotid artery blood flow.
Results: The results showed that 141 people (45
percent) had normal readings. Out of the 141 patients, 55 were admitted to a
long-term care facility, 43 patients were discharged. Ten of the patients were
unconscious or vegetative, and their relatives pleaded for their loved ones to
be removed from them. Four people died as a result of brain death, while two
others died as a result of injuries. Seventy-two patients (28%) had hypoperfusion,
and 71 died, 65 through brain death, 6 from stopping care, and one with mild
disability. Vasospasm was present in 69 individuals (27%).
Conclusion: Patients with normal
measures should have a good chance of survival. Hypoperfusion patients had a
bad prognosis. The use of nimodipine in patients with vasospasm should be
examined, but further research is needed to determine its safety and effectiveness.
TCD is helping to assess early prognosis.
Keywords: Prognosis, Transcranial Doppler,
traumatic brain injury, hypoperfusion, vasospasm
ABSTRACT
Aim: To assess the role of transcranial Doppler in
patients with severe traumatic brain injury
Study
design:
A cross-sectional study
Place
and duration:
This study was conducted at Mekran Medical college Turbat Pakistan.
Methodology:
Transcranial
Doppler (TCD) was performed on 255
patients with severe traumatic brain injury (TBI) who had a Glasgow Coma Scale
of 8 or less on admission. All the
patients were on a ventilator. TCD was performed on the first, second, third,
and seventh days of the hospital stay. Two out of three of the following were
used to define hypoperfusion: 1. A
mean velocity of less than 35 cm/sec in the middle cerebral artery 2. The
diastolic velocity of the middle cerebral artery is seen to be lesser than 20
cm/sec and 3. A pulsatility index of more than 1.4 was recorded.
The following criteria were used to identify
vasospasm: mean velocity of the middle cerebral artery more than 120 cm/sec
and Landegaarde index greater than 3. The Lindegaard index is the ratio of
middle cerebral artery blood flow to internal carotid artery blood flow.
Results: The results showed that 141 people (45
percent) had normal readings. Out of the 141 patients, 55 were admitted to a
long-term care facility, 43 patients were discharged. Ten of the patients were
unconscious or vegetative, and their relatives pleaded for their loved ones to
be removed from them. Four people died as a result of brain death, while two
others died as a result of injuries. Seventy-two patients (28%) had hypoperfusion,
and 71 died, 65 through brain death, 6 from stopping care, and one with mild
disability. Vasospasm was present in 69 individuals (27%).
Conclusion: Patients with normal
measures should have a good chance of survival. Hypoperfusion patients had a
bad prognosis. The use of nimodipine in patients with vasospasm should be
examined, but further research is needed to determine its safety and effectiveness.
TCD is helping to assess early prognosis.
Keywords: Prognosis, Transcranial Doppler,
traumatic brain injury, hypoperfusion, vasospasm