Usefulness of transcranial Doppler-derived cerebral hemodynamic parameters in the noninvasive assessment of intracranial pressure.
Wakerley BR., Kusuma Y., Yeo LL., Liang S., Kumar K., Sharma AK., Sharma VK.
BACKGROUND: Transcranial Doppler (TCD) ultrasonography is a noninvasive bedside tool that can evaluate cerebral blood flow hemodynamics in major intracranial arteries. TCD-derived pulsatility index (PI) is believed to be influenced by intracranial pressure (ICP). OBJECTIVE: To correlate TCD-PI with cerebrospinal fluid (CSF) pressure (representing ICP), measured by standard lumbar puncture (LP) manometry. METHODS: CSF pressures (CSF-P) were measured in 78 patients by LP manometry. Stable TCD spectra were obtained 5 minutes before LP from either middle cerebral arteries using Spencer's head frame and 2-MHz transducer. PI values were calculated from the TCD spectra by an independent neurosonologist. RESULTS: Factors displaying a significant relationship with CSF-P included age (R = -.426, P < .0005); EDV (R = -.328, P = .002;) and PI (R = .650, P < .0005). On analyzing dichotomized data (CSF-P < 20 vs. ≥ 20 cm H2 0) TCD-PI was an independent determinant (OR per .1 increase in PI = 2.437; 95% CI, 1.573-3.777; P < .0005). PI ≥ 1.26 could reliably predict CSF-P ≥ 20 cm H2 0 (sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were 81.1%, 96.3%, 93.8%, 88.1%, and 90.1% respectively). CONCLUSION: TCD-derived PI could be used to identify patients with CSF-P ≥ 20 cm H2 0 and may play an important role as a monitoring tool.