Publication: Peak Systolic Velocity in Middle Cerebral Artery in Patients with Severe Traumatic Brain Injury as an Indicator of Detrimental Rise in Intracranial Pressure
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Intracranial pressure (ICP) is the major concern for neurosurgeons while treating
patients with severe traumatic brain injury, as any troublesome escalation in
intracranial pressure heralds feared complications leading to definite morbidity or
even mortality.
Objective
This study focuses on analyzing the correlation between peak systolic velocity in
middle cerebral artery derived from transcranial doppler ultrasonographic spectral
analysis and intracranial pressure values derived from invasive intracranial pressure
monitoring system in a patient with severe traumatic brain injury.
Method
A prospective observational study was performed using a convenience sample
technique including all adult patients with severe traumatic brain injury who had
invasive intracranial monitors placed as part of their clinical care. Transcranial
doppler ultrasonography was performed with a 2 MHz linear probe of ACUSON X300
ultrasound system while simultaneous intracranial pressure readings were obtained
directly from invasive intracranial pressure monitoring. The association between
peak systolic velocity in the middle cerebral artery and invasive intracranial pressure
was assessed with Pearson’s correlation coefficient.
Result
One hundred one transcranial doppler ultrasound spectral analysis was performed on
26 individual patients. The mean age of the population involved in this study is 43.57
years ± S.D. 19.95 (range 18-78 years), with male preponderance in a ratio of 5.5:1.
Pearson’s correlation coefficient of peak systolic velocity in middle cerebral artery
and intracranial pressure was 0.715 (p < 0.000) demonstrating a significant positive
correlation. With further evaluation of area under curve characteristics, peak systolic
velocity in middle cerebral artery of 39.6 cm/s yielded the most favorable balance
of test characteristics to diagnose elevation of intracranial pressure, with a resulting
sensitivity of 82.1% and specificity of 84.4%.
Conclusion
Peak systolic velocity in middle cerebral artery can be explored further as a
dependable screening tool to evaluate intracranial pressure among patients with
severe traumatic brain injury in settings with unavailability of invasive intracranial
pressure monitoring facilities.
KEY WORDS
Intracranial pressure, Peak systolic velocity, Screening, Trauma
Description
Shrestha B,1 Lakshmipathy G2
1Department of Surgery, Neurosurgery Unit
Dhulikhel Hospital, Kathmandu University Hospital
Kathmandu University School of Medical Sciences
Dhulikhel, Kavrepalanchowk, Nepal
2Department of Neurosurgery
Upendra Devkota Memorial National Institute
of Neurological and Allied Sciences
Bansbari, Kathmandu, Nepal
Keywords
Intracranial pressure, Peak systolic velocity, Screening, Trauma