Evaluation of Managements for Severe Head Injury with Transcranial Doppler Ultrasound

Abstract

The efficacy and limitation of several medical managements for raised intracranial pressure (ICP) were studied in 20 patients of severe head injury by use of transcranial Doppler (TCD) ultrasound. The effects of head elevation (horizontal, 15°, 30° and 45°), hyperventilation, barbiturate and the Sendai cocktail (20% mannitol, phenytoin and viatmin E) were evaluated by measuring blood flow velocity in the middle cerebral artery (MCAFV), ICP, cerebral perfusion pressure (CPP) and cerebrovascular CO2 reactivity. The cerebrovascular CO2 reactivity was investigated by obtaining the K value in the modified Olesen's formula of cerebral blood flow calculation.As the degree of head elevation was increased, there was a gradual decrease in CPP in association with the decrease of MCAFV in 10 patients examined. These changes in CPP and MCAFV were remarkable in patients with lower GCS scores compared to those with higher GCS scores. The K values examined in 9 patients was low when the patient's GCS score were 5 or less. But as the patients GCS scores improved, the K values returned to normal nearly values. Barbiturates and the Sendai cocktail failed to improve raised ICP and also failed to improve raised ICP and reduced MCAFV in all patients whoes MCAFV were as low as 30-40cm/s before these treatments.These results indicate that noninvasive study with TCD ultrasound can provide valuable informations on optimal therapeutic measures in patients with severe head injury.