Abstract
INTRODUCTION: TCD is a non invasive ultrasound technique that allows evaluating the velocity and direction of the blood flow in the proximal segments of the principal cerebral arteries. It is mainly used to evaluate and follow up patients with vascular brain diseases, becoming an indispensable tool in multimodal monitoring in the stroke units and neurocritical care.
OBJECTIVE: to highlight the importance of transcranial Doppler (TCD) as a diagnostic and therapeutic tool in complex cerebrovascular diseases handled in the critical care units.
METHODS: a bibliographic Medline search was done between February and April 2007, using as a main term (MeSH) Transcranial Doppler, linked with vasospasm, flow velocity, pulsatility index, stroke, and death. We found 1767 articles published from 1972 to 2006. We used databases like Hinari, Ovid and Science Direct to access the respective literature. We included observational analytic and experimental studies in humans as well as in animals that analyzed the utility of TCD in the evaluation of the main neurovascular diseases. Furthermore, seven reviews were included. Afterwards, analysis and discussion were carried out by the neurovascular research group of the “Fundación Cardiovascular de Colombia”, which is composed of two neurologists, one
epidemiologist, and general physicians trained in TCD technique. Only indexed journals were reviewed, which limited the access to Latin-American literature.
RESULTS: TCD can identify vasospasm processes after subarachnoid hemorrhage and proximal flow
occlusions evaluate cerebrovascular autoregulation and confirm clinical brain death. Recent research has postulated that its use can produce structural changes in the thrombus and thus be useful as a co-adjuvant in thrombolytic therapy.
CONCLUSIONS: TCD is a reliable, reproducible and low cost technique, important for the diagnosis and follow up of patients with neurovascular diseases that require strict medical care and intracranial pressure monitoring. Supports the clinical death diagnosis furthermore determinates indication of transfusion in falciform anemia patients. New studies are required to confirm the utility of TCD as a coadjutant thrombolytic therapy.
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