Study on the cerebral hemodynamic changes by transcranial Doppler ultrasonography from emergency periods to stable periods in severe acute encephalopathy children

Abstract

Objective To evaluate the correlations between the cerebral hemodynamic changes of severe acute encephalopathy with the clinical features from emergency periods to stable periods and the value of transcranial Doppler ultrasonography(TCD) in cerebral function assess. Methods Thirty patients with acute brain diseases by assisted mechanical ventilator from Jun 2014 to May 2015 in PICU were included and followed up to Nov 2015, then grouped by Glasgow Coma Scale(GCS), MRI, prognosis(mental sequelae after half a year). Each subject was examined through the temporal bone window by TCD at emergency periods and stable periods.The systolic cerebral blood flow velocity(sCBFV), and pulsatility index(PI) of bilateral middle cerebral artery(MCA), anterior cerebral artery, posterior cerebral artery were analyzed.Multivariant analysis of variance, repeated measures analysis of variance was conducted to compare sCBFV and PI of MCA among groups in different clinical periods.The variants included sex, disease diagnosis, prognosis, MRI, GCS, and the first abnormal TCD.The variation within groups was tested via a Hotelling T2 test.All sCBFV and PI of each artery and the D-value of sCBFV between the different periods were compared according to the prognosis groups. Results (1) Five patients could be lateralized, and their lateralization of MRI focus was consistent with the abnormal sides of sCBFV in the stable periods.(2) The D-value of sCBFV in left MCA between the different periods in the poor prognosis group was significantly higher than that in the good prognosis group[(71.93±58.21) cm/s vs.(33.20±30.23) cm/s, t=-2.287, P=0.033]. (3) Multivariant analysis of variance showed that GCS classification and disease diagnosis were significantly correlated with the cerebral hemodynamic changes respectively(P=0.042, 0.005, respectively). (4) sCBFV and PI of left MCA reduced significantly in the stable periods than those in the emergency periods(P=0.002, 0.003, respectivly). Conclusion The cerebral hemodynamic changes by TCD from emergency periods to stable periods are consistent with the clinical status, dynamic evaluation by TCD may facilitate the evaluation of brain dysfunction in the severe acute encephalopathy. Key words: Severe acute encephalopathy; Cerebral hemodynamic; Transcranial Doppler ultrasonography; Glasgow Coma Scale; Prognosis,