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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:1049-1053 • 0278-4297

Monitoring of Increased Intracranial Pressure Resulting From Cerebral Edema With Transcranial Doppler Sonography in Patients With Middle Cerebral Artery Infarction

Talip Asil, MD, Ilkay Uzunca, MD, Ufuk Utku, MD and Ufuk Berberoglu, MD

Departments of Neurology (T.A., I.U., U.U.) and Public Health (U.B.), Trakya University, Edirne, Turkey.

Address correspondence and reprint requests to Talip Asil, MD, Department of Neurology, Trakya University Medicine Faculty, 22030 Edirne, Turkey. E-mail: talip_asil{at}yahoo.com.

Objective. Cerebral herniation resulting from postischemic brain edema is the most common cause of death in patients with large cerebral infarctions. Early monitoring of intracranial pressure and application of necessary treatment procedures may have life-saving value. In this study, the data obtained by transcranial Doppler sonography were compared with clinical examination and the neuroradiologic findings. Methods. Eighteen patients with first-ever strokes and large middle cerebral artery infarction who were admitted within the first 12 hours after stroke onset were included. Clinical findings were evaluated according to the daily Glasgow Coma Scale and Rankin disability scores on the 10th day. Initial cerebral computed tomography was performed at admission to the hospital. Midline shift and ventricular displacement were evaluated on the third day. Follow-up tomographic scans of some patients were performed on subsequent days if necessary. Systolic, diastolic, and mean blood flow velocities and pulsatility indices of all patients were measured by transcranial Doppler sonography daily for 10 days. Results. The pulsatility indices were higher on the third hospital day than on the first day. The increases in the pulsatility indices were correlated with the midline shift measured on the third day. The prognoses of the patients whose maximal pulsatility indices during the first 10 days were higher than 1.5 were poorer than those of the patients whose maximal pulsatility indices were lower than 1.5. Conclusions. Transcranial Doppler sonography enables noninvasive monitoring of raised intracranial pressure in patients with large infarctions. It also provides information for detecting cerebral herniation and deciding on the medical or surgical therapy.

Key Words: raised intracranial pressure • stroke • transcranial Doppler sonography

Abbreviations: CCT, cerebral computed tomographic • GCS, Glasgow Coma Scale • MCA, middle cerebral artery • RDS, Rankin disability score • TCD, transcranial Doppler

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Copyright © 2003 by the American Institute of Ultrasound in Medicine.