Neurocritical Care Interventions

Transcranial dopplers

Transcranial Doppler (TCD) monitoring is a key component of any Neurocritical care unit that specializes in managing patients with subarachnoid hemorrhage, or brain hemorrhage from aneurysm rupture. Vasospasm, or spasming of the arteries after a subarachnoid hemorrhage, occurs 6 to 14 days after an aneurysm. This leads to death or disability in 40% of patients who initially survive there SAH. TCD monitoring is a non-invasive way for physicians to monitor for vasospasm and initiate treatment.

TCD monitoring measures blood flow velocity in the large arteries of the brain. When the arteries spasm, they become smaller. In order for the same amount of blood flow to travel through a smaller artery, the velocity that the blood travels must increase. Therefore, TCD’s can detect vasospasm by detecting an elevation in blood velocity of the brain arteries before patients exhibit the typical stroke like symptoms of vasospasm. Doctors, in turn, can then initiate treatment before symptoms occur.