473-149 | Changes on Continuous Transcranial Doppler During Treatment for Elevated Intracranial Pressure-JVU 473-149

JVU 473-149

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This article discusses the use of continuous transcranial Doppler (cTCD) monitoring to assess changes in cerebral blood flow in a patient with elevated intracranial pressure. The patient in the case study is a 53-year-old man with alcohol-related cirrhosis who developed peritonitis and esophageal variceal hemorrhage. He subsequently experienced septic and hemorrhagic shock, acute-on-chronic liver failure, and cerebral edema with convulsive status epilepticus.<br /><br />cTCD monitoring was performed on the left and right middle cerebral arteries (MCAs) before, during, and after treatment with hypertonic saline. The monitoring captured an initial high pulsatility index (PI) in response to systemic hypotension, indicating an intracranial vasodilatory response. This led to elevated intracranial pressure and increased resistance to flow. When the hypotension resolved, the mean velocity (MV) increased and the PI began to drop. Approximately 15 minutes after initiating therapy for elevated intracranial pressure, the MV and PI stabilized and returned to normal.<br /><br />The use of cTCD allowed for effective noninvasive real-time monitoring of elevated intracranial pressure and the evaluation of its response to treatment. The findings suggest that cTCD monitoring can be a valuable tool in managing patients with elevated intracranial pressure and optimizing treatment strategies.<br /><br />The authors declare no conflicts of interest and did not receive any funding for this research.

Keywords

continuous transcranial Doppler monitoring

cTCD monitoring

cerebral blood flow

intracranial pressure

alcohol-related cirrhosis

peritonitis

esophageal variceal hemorrhage

septic shock

hemorrhagic shock

acute-on-chronic liver failure