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Chapter 24 - New Frontiers in Neuroprognostication: Point-of-Care Ultrasonography

from Part II - Other Topics in Neuroprognostication

Published online by Cambridge University Press:  14 November 2024

By
Collin Herman ,
Jonathan Gomez  and
Aarti Sarwal
Edited by
David M. Greer  and
Neha S. Dangayach
David M. Greer
Affiliation:
Boston University School of Medicine and Boston Medical Center
Neha S. Dangayach
Affiliation:
Icahn School of Medicine at Mount Sinai and Mount Sinai Health System
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Summary

Clinical examination is central to prognostication in acute brain injury but it has its limitations, especially in presence of confounders like sedation, recent cardiac arrest or lack of access to full exam due to concomitant injuries.[1–3] Lack of robust clinical prognostication tools has allowed the possibility of scenarios where clinicians may withdraw care prematurely due to a presumed poor prognosis based on a poor neurological exam.[4] Conversely, clinicians may defer prognostication in a confounded neurological exam and maintain patients on advanced life support for days before the degree of neurological injury becomes manifest.[5] In some of these scenarios, cerebral hemodynamic evaluation using transcranial Doppler (TCD) may provide a noninvasive surrogate to assess cerebral perfusion and augment available information to aid in prognostication.

Introduced in 1982 as a noninvasive means of assessing cerebral blood flow by measuring velocities in intracranial vasculature, TCD has become a mainstay for evaluation of cerebrovascular hemodynamics in stroke and subarachnoid hemorrhage.[6]

Type
Chapter
Information
Neuroprognostication in Critical Care , pp. 328 - 339
Publisher: Cambridge University Press
Print publication year: 2024

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