Lau Vincent Issac, Arntfield Robert Thomas
Department of Medicine, Division of Critical Care, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
London Health Sciences Centre, Victoria Hospital Rm, D2-528, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
Crit Ultrasound J. 2017 Oct 13;9(1):21. doi: 10.1186/s13089-017-0077-9.
In the unconscious patient, there is a diagnostic void between the neurologic physical exam, and more invasive, costly and potentially harmful investigations. Transcranial color-coded sonography and two-dimensional transcranial Doppler imaging of the brain have the potential to be a middle ground to bridge this gap for certain diagnoses. With the increasing availability of point-of-care ultrasound devices, coupled with the need for rapid diagnosis of deteriorating neurologic patients, intensivists may be trained to perform point-of-care transcranial Doppler at the bedside. The feasibility and value of this technique in the intensive care unit to help rule-in specific intra-cranial pathologies will form the focus of this article. The proposed scope for point-of-care transcranial Doppler for the intensivist will be put forth and illustrated using four representative cases: presence of midline shift, vasospasm, raised intra-cranial pressure, and progression of cerebral circulatory arrest. We will review the technical details, including methods of image acquisition and interpretation. Common pitfalls and limitations of point-of-care transcranial Doppler will also be reviewed, as they must be understood for accurate diagnoses during interpretation, as well as the drawbacks and inadequacies of the modality in general.
在昏迷患者中，神经体格检查与更具侵入性、成本更高且可能有害的检查之间存在诊断空白。经颅彩色编码超声检查和二维经颅多普勒脑成像有可能成为在某些诊断中弥合这一差距的中间手段。随着床旁即时超声设备的日益普及，加上需要对病情恶化的神经科患者进行快速诊断，重症监护医生可接受培训，在床边进行床旁经颅多普勒检查。这项技术在重症监护病房中帮助确诊特定颅内病变的可行性和价值将成为本文的重点。本文将提出并通过四个典型病例说明重症监护医生进行床旁经颅多普勒检查的适用范围：中线移位、血管痉挛、颅内压升高和脑循环停止的进展情况。我们将回顾技术细节，包括图像采集和解读方法。还将回顾床旁经颅多普勒检查的常见陷阱和局限性，因为在解读过程中必须了解这些内容才能做出准确诊断，同时也将探讨该检查方式总体上的缺点和不足。
