Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy.
Eur Neurol. 2010;63(3):164-9. doi: 10.1159/000286232. Epub 2010 Feb 18.
Transcranial Doppler (TCD) is a sensitive technique for circulatory arrest diagnosis in brain death when patterns such as reverberant flow and short systolic spikes are observed. In infants, the nonossified fontanelles compensate for intracranial hypertension. We describe TCD patterns in infants with brain death, different from adults, with the hemodynamic modifications induced by anterior fontanelle compression.
TCD was performed in 2 infants with diagnosed brain death admitted to the neonatal intensive care unit.
TCD showed a large peak 'reverberant' flow, with a high peak systolic velocity and a consistent retrograde component, away from the brain. Compression of the anterior fontanelle induced, at first, a reduction in systolic flow with the subsequent appearance of the characteristic short systolic spikes. Upon compression removal, a brief increase in the systolic flow was observed before the prompt reappearance of the reverberant flow.
TCD for brain death diagnosis should be done cautiously in infants. In these cases, reverberating flow may be indicative of circulatory arrest even if with a large peak and with a high peak systolic velocity. Heavy fontanelle compression may reproduce the classical adult TCD patterns of brain death, thus supporting the diagnosis of cerebral circulatory arrest.
经颅多普勒（TCD）是诊断脑死亡时循环停止的敏感技术，当观察到回旋流和短收缩峰等模式时。在婴儿中，未骨化的囟门补偿颅内压升高。我们描述了与成人不同的脑死亡婴儿的 TCD 模式，这些模式与前囟门压缩引起的血流动力学改变有关。
对 2 例被诊断为脑死亡并入住新生儿重症监护病房的婴儿进行 TCD 检查。
TCD 显示出一个大的高峰“回旋”流，具有高的收缩峰速度和一致的逆行成分，远离大脑。前囟门的压缩首先导致收缩期血流减少，随后出现特征性的短收缩峰。在前囟门压力释放后，观察到收缩期血流短暂增加，随后迅速出现回旋流。
在婴儿中进行脑死亡诊断的 TCD 检查应谨慎进行。在这些情况下，即使存在高峰和高收缩峰速度，回旋流也可能表明循环停止。前囟门的重度压迫可能会重现成人 TCD 模式，从而支持脑循环停止的诊断。
