Transcranial color-coded sonography in head injury

Abstract

Sir, We read with interest the recent article by Kochanowicz et al., “Detection and monitoringofcerebraldisturbanceswith transcranial color-coded sonography in patients with head injury” [1]. In this preliminaryreport,theauthorsshowthat low end-diastolic velocities and low resistance index values are associated with poor outcome in patients with moderate to severe head injury. The authorsalsostatethatreportsconcerning the use of transcranial color-coded sonography (TCCS) in traumatic brain injury (TBI) are scarce and based on small patient groups. We agree with the authors that TCCS is infrequently used in TBI patient monitoring in neurocritical care units compared to conventional transcranial Doppler sonography. In our Neurocritical Intensive Care Unit, TCCS is routinely used to monitor TBI patients. We would like to point out that along with the advantages in cerebral hemodynamic evaluations described by the authors, TCCS can monitor midline shift in patients with TBI, achieving good correlation with cranial computed tomography (CT) measurements [2]. The detection of posttraumatic carotid cavernous fistulas at a non-symptomatic stage has also been recently described [3]. We concur with the authors’ conclusions regarding the advantages of TCCS over conventional and blind transcranial Doppler sonography [4]. We appreciate the findings that Dr Krejza’s group presents on the use of TCCS in TBI patients. We expect TCCS to be more widely used in patients with head injury, as this will enhance the quality of multimonitoring of TBI patients with the aim of decreasing secondary ischemic insults.