Transcranial Doppler In Children Research Articles

Transcranial Doppler in children with sickle cell disease: Five years of screening experience.

Sickle cell disease (SCD) is an autosomal recessive, inherited disorder of haemoglobin. Children with sickle cell disease (SCD) are at risk of vascular occlusions. If this occurs in the brain, it can result in stroke. Stroke is the leading cause of death and disability in children with SCD.Transcranial Doppler (TCD) has been shown to accurately predict those children at risk of stroke so appropriate preventative treatment can commence. TCD screening with a non-imaging Doppler machine to assess stroke risk has been in operation at our institution for 5years. Eighty-eight patients attending the haematology clinic for SCD are scanned annually. If abnormal velocities are found, repeat scans are performed at close interval to ensure results are reproducible. No child has had a stroke since the start of our screening. Seven of the eighty-eight patients have shown high velocities on annual screening. The introduction of a TCD programme at out institution has identified children at risk of stroke so they can be closely monitored and potentially receive prophylactic treatment.

Stroke transcranial Doppler in children with human immunodeficiency virus.

To describe stroke syndromes and transcranial Doppler (TCD) findings in children with human immunodeficiency virus (HIV) and examine the associations between TCD and clinical and laboratory data. We enrolled 42 children (24 males, 18 females) with HIV (median age=7y 6mo; 2y 7mo-15y 6mo), with and without stroke who underwent a TCD examination of the anterior and posterior circulations to derive time-averaged maximum mean velocity (TAMMV) measurements for comparison with previous studies. Clinical and laboratory variables were extracted from the medical records. Of the 42 children with HIV, five had right-sided hemiparesis, three had chronic lung disease, two occurred post-varicella infection, one after herpetic oral ulceration, and one had a poorly functioning left ventricle. Neuroimaging showed middle cerebral artery (MCA) TAMMV greater than 200cm/s, moyamoya-like arteriopathy, left basal ganglia infarction with ipsilateral stenosis, hygroma consistent with venous thrombosis, and a hyperdense left MCA. Eight neurologically asymptomatic children had atypical TCD. The CD4 cell count was non-significantly lower in 6 out of 30 children with atypical TCD (median=21.5; interquartile range=16.1-26.5) compared with the remainder (median=29; interquartile range=21.3-35.0; p=0.09). A variety of stroke syndromes occur in children with HIV. TCD suggests atypical intracranial vessels and/or haemodynamics in some children with HIV infection, consistent with vasculopathy, possibly related directly to immunodeficiency and/or infection. A range of stroke syndromes are found in children with human immunodeficiency virus (HIV). Transcranial Doppler (TCD) velocities in HIV are commonly outside the range for typically developing children. TCD and neuroimaging data in children with HIV suggest intracranial vasculopathy as one mechanism for stroke. CD4 cell count is non-significantly lower in children with HIV and atypical TCD.

23. Role of trans-cranial Doppler in children with acute liver failure – A prospective observational pilot study

Background and Aims: Early detection of raised intracranial pressure improves outcome in acute liver failure (ALF). We evaluated role of bedside transcranial doppler (TCD) in ALF children for feasibility, correlation with severity of hepatic encephalopathy (HE) and predicting outcome. Methods: 28 ALF children [24 boys, 11 (5–18 years)] with HE (grade I–II = 9, III–IV = 19) and 47 healthy controls [30 boys, 11 (5–18 years)] were prospectively enrolled. Demographic, clinical and laboratory parameters were recorded. Expert radiologist performed TCD of middle cerebral artery (MCA) with 2 MHz probe through temporal window. Peak systolic velocity (Vs), end diastolic velocity (Vd), mean flow velocity (mFV), pulsatility (PI) and resistive index (RI) were calculated by electronic calipers. PI ≥ 1.2 was suggestive of raised ICP. Results: TCD could be performed in all patients and healthy controls except one with poor window. TCD parameters in controls and ALF with grade I–II HE and III–IV HE are shown in Table 1. The peak systolic velocity, PI and RI showed an increasing trend from controls to HE grade I–II to grade III–IV (Table 1). ALF children with HE grade III–IV had significantly higher peak systolic velocity, PI and RI as compared to controls. However, the difference in peak systolic velocity, PI and RI in ALF patients with HE grade I-II versus controls and ALF with HE I-II versus III-IV was not statistically significant. ALF children with PI ≥ 1.2 (n = 7) more often had severe grade (III-IV) of HE (7/7 vs. 12/21; p = 0.03) and poorer outcome (0/7 vs. 8/21 survival without transplantation; p = 0.05) than those with PI < 1.2 (n = 21). Conclusions: Transcranial doppler is feasible in ALF children. The PI, RI and peak systolic velocity of MCA are higher in ALF with grade III-IV HE then controls but they do not differentiate between grades of HE. PI ≥ 1.2 is a predictor of poor outcome. The authors have none to declare.

Findings in Transcranial Doppler in Children with Sickle Cell Disease in Nigeria

Findings in Transcranial Doppler in Children with Sickle Cell Disease in Nigeria

Use of Transcranial Doppler for Management of Central Nervous System Infections in Critically Ill Children

BackgroundThe primary objective of this study was to characterize changes in cerebral blood flow measured using transcranial Doppler in children with central nervous system infections. We hypothesized that children with central nervous system infections have abnormal cerebral blood flow, associated with a greater frequency of complications and poor neurological outcome. MethodsWe conducted a single-center, retrospective study of children admitted to the neonatal or pediatric intensive care unit with central nervous system infection and undergoing transcranial Doppler as part of routine care between March 2011 and July 2015. ResultsA total of 20 children with central nervous system infection underwent 35 transcranial Dopplers. The mean age was 8.2 ± 6.3 years, including 12 boys and eight girls. The most common infection was meningitis (n = 11, 55%), with the remainder comprising encephalitis (15%), meningoencephalitis (20%), and abscess or empyema (10%). Bacterial (n = 10, 50%) and viral (n = 6) sources were common with only one (5%) fungal infection and three (15%) unknown but presumed viral etiology. The patients underwent transcranial Doppler 4 ± 9 days after intensive care unit admission. Mean cerebral blood flow velocities were overall increased compared with reference values for age (healthy children and critically ill children) mostly because of hyperemia (n = 21, 60%) and vasospasm (6%). Hypoperfusion (cerebral blood flow velocity <1 S.D. of normal value) in at least one vessel was associated with morbidity (intubation, vasoactive medications, neurosurgery, cardiac arrest) (P = 0.04) and mortality (P = 0.03). Two patients had increased intracranial pressure and hyperventilation was safely achieved with transcranial Doppler monitoring to avoid ischemia. Serial transcranial Dopplers were used to guide blood pressure management. ConclusionsTranscranial Doppler can be used in children with central nervous system infection as a tool to assess cerebral blood flow. In this retrospective study, cerebral hypoperfusion was associated with increased morbidity and mortality. If transcranial Doppler is to guide medical therapy and management of cerebral blood flow in children with central nervous system infections, these results will need to be validated in prospective studies with a more homogenous population of children with encephalitis or meningitis.

Reticulocyte count is the most important predictor of acute cerebral ischemia and high-risk transcranial Doppler in a newborn cohort of 395 children with sickle cell anemia.

Stroke is a severe clinical manifestation of sickle cell anemia (SCA). Despite the prognostic relevance of transcranial Doppler (TCD), more accurate tools to assess stroke risk in children with SCA are required. Here, we describe the effect of clinical, laboratory, and molecular features on the risk of stroke and high-risk TCD in children from the newborn cohort of Minas Gerais, Brazil. Outcomes studied were acute cerebral ischemia and high-risk TCD. Clinical and hematological data were retrieved from children's records. Genetic markers, which were known for their association with stroke risk, were genotyped by polymerase chain reaction/restriction fragment length polymorphism and sequencing. The cumulative incidence of acute cerebral ischemia by the age of 8years was 7.4% and that of high-risk TCD by the age of 11.5years was 14.2%. The final multivariate model for acute cerebral ischemia risk included high white blood cell count and reticulocyte count, acute chest syndrome rate, and the single nucleotide polymorphisms (SNPs) TEK rs489347 and TNF-α rs1800629. The model for high-risk TCD included high reticulocyte count and the SNPs TEK rs489347 and TGFBR3 rs284875. Children with risk factors should be considered for intensive risk monitoring and for intervention therapy.

Detection of Cerebral Vasculopathy by Transcranial Doppler in Children With Neurofibromatosis Type 1.

Neurofibromatosis type 1 is characterized by nerve sheath neurofibromas associated with a number of additional clinical features, including cerebrovascular disease. The aim of this study was to use transcranial Doppler as a screening method for identifying cerebral vasculopathy in children with neurofibromatosis type 1. Forty children with neurofibromatosis type 1, aged 5 to 18 years old, were examined by transcranial Doppler. Patients presenting with hemodynamic features of arterial stenosis/occlusion on transcranial Doppler underwent magnetic resonance angiography to confirm the findings. Magnetic resonance angiography was performed on 4 children who exhibited a transcranial Doppler hemodynamic pattern indicative of cerebral vasculopathy. Among these cases, 2 presented internal carotid artery stenosis/occlusion, 1 had bilateral middle cerebral artery stenosis, and 1 presented a normal magnetic resonance angiography result. Transcranial Doppler can be used routinely in the investigation of cerebrovascular disease in neurofibromatosis type 1 patients, where magnetic resonance angiography can be subsequently applied to confirm the diagnosis, further contributing to the prevention of cerebrovascular events.

Correlation between intracranial pressure and pulsatility index measured by transcranial Doppler in children with severe trauma brain injury

This study was designed to see whether there is a correlation between the transcranial Doppler (TCD) parameters and the CCP and intracranial pressure (ICP) monitoring during the cerebral hemodynamic changes and to evaluate ICP indirectly by TCD.

Transcranial Doppler in children

Transcranial Doppler US, a non-invasive tool for evaluating the cerebral arteries, has evolved significantly during the last two decades. This review describes the practical procedure, and summarises and illustrates its established and "work-in-progress" indications in children. Indications for a transcranial Doppler US examination include, but are not limited to: (1) evaluation of cerebral blood flow velocities in the circle of Willis in patients with sickle cell anaemia to guide transfusion therapy; (2) diagnosis and follow-up of vasculopathy, such as moyamoya disease; (3) diagnosis and monitoring of acute cerebrovascular disorders in intensive care patients, in particular following traumatic brain injury, and during cardiovascular surgery; and (4) confirmation of a clinical diagnosis of brain death by documentation of cerebral circulatory arrest.

Brazilian Guidelines for transcranial doppler in children and adolescents with sickle cell disease

Background Sickle cell disease is the most common monogenic hereditary disease in Brazil. Although strokes are one of the main causes of morbidity and mortality in these patients, the use of transcranial Doppler to identify children at risk is not universally used. Objective To develop Brazilian guidelines for the use of transcranial Doppler in sickle cell disease children and adolescents, so that related health policies can be expanded, and thus contribute to reduce morbidity and mortality. Methods The guidelines were formulated in a consensus meeting of experts in transcranial Doppler and sickle cell disease. The issues discussed were previously formulated and scientific articles in databases (MEDLINE, SciELO and Cochrane) were carefully analyzed. The consensus for each question was obtained by a vote of experts on the specific theme. Results Recommendations were made, including indications for the use of transcranial Doppler according to the sickle cell disease genotype and patients age; the necessary conditions to perform the exam and its periodicity depending on exam results; the criteria for the indication of blood transfusions and iron chelation therapy; the indication of hydroxyurea; and the therapeutic approach in cases of conditional transcranial Doppler. Conclusion The Brazilian guidelines on the use of transcranial doppler in sickle cell disease patients may reduce the risk of strokes, and thus reduce the morbidity and mortality and improve the quality of life of sickle cell disease patients.

Brazilian Guidelines for transcranial doppler in children and adolescents with sickle cell disease

Brazilian Guidelines for transcranial doppler in children and adolescents with sickle cell disease

The results of transcranial Doppler in children – how to verify the indications?

The results of transcranial Doppler in children – how to verify the indications?

Transcranial Doppler Ultrasound in Children with Sturge-Weber Syndrome

Transcranial Doppler ultrasound is a noninvasive vascular assessment technique proved useful in the management of pediatric disorders predisposed to stroke and may have similar utility for Sturge-Weber syndrome. Eight children with Sturge-Weber syndrome had velocities measured in the major cerebral arteries via the Stroke Prevention Trial in Sickle Cell Anemia methodology. Velocities and pulsatility indexes were compared between the unaffected and affected sides. All subjects had reduced velocity on the affected side; the mean middle cerebral artery percentage difference was 20% (95% CI, 15%-25%). Pulsatility index was increased on the affected side; mean middle cerebral artery pulsatility index percentage difference, 34% (95% CI, 15%-53%). Six subjects also had reduced posterior cerebral artery velocity on the affected side. Side-to-side differences in middle cerebral artery and posterior cerebral artery velocities correlated with severity of MRI asymmetry (Spearman rho = 0.88, P = .02). Decreased arterial flow velocity and increased pulsatility index in the middle cerebral artery and posterior cerebral artery suggests a high resistance pattern that may reflect venous stasis and may contribute to chronic hypoperfusion of brain tissue. Further study of Transcranial Doppler in children with Sturge-Weber syndrome is indicated.