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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5813_Библиотеки_им_академика_М_И_Перельмана.pdf
Contents
6.5 Learning Through Guidelines and Practice Standards . . . . . . . 60
6.6 Competence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Part II Basic and Advanced Parameters
7 Flow Velocity, Pulsatility Index, Autoregulation,
and Critical Closing Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Marta Fedriga and Marek Czosnyka
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
7.2 Flow Velocity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
7.3 Pulsatility Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7.4 Critical Closing Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7.5 Autoregulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.5.1 Static Autoregulation . . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.5.2 Dynamic Autoregulation . . . . . . . . . . . . . . . . . . . . . . . 70
7.5.3 Continuous Monitoring of Autoregulation . . . . . . . . . . 71
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
8 Transcranial Doppler and Optic Nerve Ultrasonography
for Non- invasive ICP Assessment . . . . . . . . . . . . . . . . . . . . . . . . . 75
Danilo Cardim and Chiara Robba
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
8.2 TCD-Derived Pulsatility Index . . . . . . . . . . . . . . . . . . . . . . . . 76
8.3 Methods Based on the Calculation of Non- invasive
CPP (nCPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
8.3.1 Aaslid etal. (nICPAaslid) . . . . . . . . . . . . . . . . . . . . . . 81
8.3.2 Czosnyka etal. (nICPFVd) . . . . . . . . . . . . . . . . . . . . . 81
8.3.3 Edouard etal. (nICP
8.3.4 Varsos etal. (nICP
) . . . . . . . . . . . . . . . . . . . . . . 84
Edouard
) . . . . . . . . . . . . . . . . . . . . . . . . . 84
CrCP
8.3.5 Abecasis and Cardim etal. (Spectral nCPP) . . . . . . . . 85
8.4 Methods Based on Mathematical Models Associating
Cerebral Blood Flow Velocity and Arterial Blood Pressure . . 85
8.4.1 Black-Box Model for ICP Estimation (nICPBB) . . . . . 85
8.4.2 Cerebrovascular Dynamics Model
for Estimation of ICP (nICP
) . . . . . . . . . . . . . . . . . 88
Heldt
8.4.3 Models Based on Non-linear Models
Between Arterial Blood Pressure and
Cerebral Blood Flow Velocity . . . . . . . . . . . . . . . . . . . 89
8.4.4 Semi-supervised Machine Learning . . . . . . . . . . . . . . 89
8.5 Optic Nerve Sheath Diameter Measurement . . . . . . . . . . . . . . 90
8.6 Take-Home Message for Clinicians . . . . . . . . . . . . . . . . . . . . . 91
8.7 Final Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
xiii
9 Cerebral Perfusion: Practical Contributions of Transcranial
Doppler at Bedside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Carla B. Rynkowski and Marcel J. Aries
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
9.2 TCD: Velocity or Flow? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
xiv
9.3 Detection of Conditions That Affect Cerebral Perfusion . . . . . 97
9.3.1 Noninvasive Estimation of Intracranial
Pressure (ICP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
9.3.2 Cerebral Vasospasm . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
9.3.3 Hyperperfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
9.3.4 Hypoperfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
9.3.5 Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
9.4 Applications of TCD Evaluating Cerebral
Perfusion in Common ICU Pathologies . . . . . . . . . . . . . . . . . . 99
9.4.1 Acute Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
9.4.2 Severe Traumatic Brain Injury . . . . . . . . . . . . . . . . . . . 102
9.4.3 Post-out-of-hospital Cardiac Arrest Syndrome . . . . . . 103
9.4.4 Acute Liver Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
9.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Part III Pathology and Clinical Applications:
Emergency Department
10 Emergency Department and Prehospital Brain
US as Part of POCUS and US Multiorgan Evaluation . . . . . . . . 109
Gabriele Via, Tomislav Petrovic, and Frank A. Rasulo
10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
10.2 BUS in Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
10.3 BUS Within Whole-Body Ultrasound in Cardiac
Arrest and the Post-resuscitation Syndrome . . . . . . . . . . . . . 116
10.4 BUS Within Whole-Body Ultrasound in Multiple
Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Contents
Part IV Pathology and Clinical Applications: General ICU
11 Sepsis, Liver Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Giovanni Volpicelli
11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
11.2 Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
11.3 Liver Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
11.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
12 Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Victoria A. McCredie
12.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
12.2 Acute Ischemic Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
12.2.1 Diagnosis of Stroke Etiology . . . . . . . . . . . . . . . . . . 140
12.2.2 Diagnosis of Large Vessel Occlusion . . . . . . . . . . . . 140
12.2.3 Monitoring of Recanalization . . . . . . . . . . . . . . . . . 141
12.2.4 Cerebral Autoregulation . . . . . . . . . . . . . . . . . . . . . . 143
12.2.5 Hemorrhagic Transformation . . . . . . . . . . . . . . . . . . 144
12.2.6 Midline Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
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12.2.7 Multimodal Neuromonitoring Approach . . . . . . . . . 146
12.2.8 Sonothrombolysis . . . . . . . . . . . . . . . . . . . . . . . . . . 147
12.3 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
13 Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Ilaria Alice Crippa and Fabio Silvio Taccone
13.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
13.2 TCD During Cardiopulmonary Resuscitation . . . . . . . . . . . . 152
13.3 Post-resuscitation Care and Neuro-Prognostication . . . . . . . 154
13.4 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
14 Severe Respiratory Failure: ARDS and ECMO . . . . . . . . . . . . . . 161
Alberto Gof, Airton Leonardo de Oliveira Manoel,
and Chiara Robba
14.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
14.2 Brain Ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
14.2.1 PEEP and Recruitment Maneuvers . . . . . . . . . . . . . 162
14.2.2 Prone Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
14.2.3 ECMO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
14.2.4 Identication of Right-to-Left Shunt with TCD . . . 166
14.3 General Ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
14.3.1 Lung Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
14.3.2 Cardiac Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . 166
14.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Part V Pathology and Clinical Applications: Neuro-ICU
15 Intracerebral Hematomas, Midline Shift, Hydrocephalus . . . . . 173
Pedro Kurtz, Daniel Paes de Almeida dos Santos,
and Ivan Rocha Ferreira da Silva
15.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
15.2 Cerebral Hemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
15.2.1 Pulsatility Index, Blood Flow Velocities,
and Cerebral Autoregulation . . . . . . . . . . . . . . . . . . 175
15.3 Intracerebral Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
15.4 Midline Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
15.5 Other Parameters and Applications . . . . . . . . . . . . . . . . . . . . 178
15.5.1 Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
15.5.2 Subdural Hematomas . . . . . . . . . . . . . . . . . . . . . . . . 178
15.5.3 Cerebral Venous Drainage Assessment . . . . . . . . . . 179
15.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
15.7 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
xvi
16 Vasospasm After Subarachnoid Hemorrhage . . . . . . . . . . . . . . . 183
Mypinder Sekhon, Oliver Ayling, and Peter Gooderham
16.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
16.2 Pathophysiology of Cerebral Vasospasm
and Delayed Cerebral Ischemia . . . . . . . . . . . . . . . . . . . . . . . 184
16.3 Diagnosis of Cerebral Vasospasm and Delayed
Cerebral Ischemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
16.4 Transcranial Doppler Principles . . . . . . . . . . . . . . . . . . . . . . . 185
16.5 Other Diagnostics of Cerebral Vasospasm . . . . . . . . . . . . . . . 187
16.6 Prevention of Vasospasm/Delayed Cerebral Ischemia . . . . . . 188
16.7 Management of Symptomatic Vasospasm . . . . . . . . . . . . . . . 188
16.8 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
17 Brain US in the Neurological Settings . . . . . . . . . . . . . . . . . . . . . . 193
Piergiorgio Lochner and Andrea Naldi
17.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
17.2 Pseudotumor Cerebri Syndrome . . . . . . . . . . . . . . . . . . . . . . 195
17.3 Low-Pressure Syndromes, Cerebrospinal Fluid (CSF)
Leaks, and Therapeutical Approaches:
Intracranial Hypotension, Patch Test . . . . . . . . . . . . . . . . . . . 196
17.4 Posterior Reversible Encephalopathy Syndrome (PRES) . . . 196
17.5 Acute Mountain Sickness (AMS) . . . . . . . . . . . . . . . . . . . . . 196
17.6 Optic Neuritis and Non- arteritic Ischemic Optic
Neuropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
17.7 Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
17.8 Infections of Central Nervous System . . . . . . . . . . . . . . . . . . 198
17.9 Intracranial Stenosis and Systemic Vasculitis . . . . . . . . . . . . 199
17.10 Parenchymal B Sonography in Neurodegenerative
Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
17.11 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Contents
18 Brain Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Charu Mahajan, Indu Kapoor, and Hemanshu Prabhakar
18.1 Pathophysiology of Brain Death . . . . . . . . . . . . . . . . . . . . . . 205
18.2 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
18.3 TCD Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
18.3.1 False-Positive and False- Negative Results . . . . . . . . 209
18.3.2 Other Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Part VI Pathology and Clinical Applications:
Applications in Neurosurgery
19 Intraoperative Echo in TBI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Carlo Giussani, Erik Pietro Sganzerla, Francesco Prada,
and Andrea Di Cristofori
19.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
19.2 Utility of ioUS in TBI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
19.2.1 Intraoperative Use of US . . . . . . . . . . . . . . . . . . . . . 217
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19.2.2 Possible Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . 218
19.2.3 Explanatory Cases . . . . . . . . . . . . . . . . . . . . . . . . . . 218
19.3 Future Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
20 Neurosonology in Tropical Medicine . . . . . . . . . . . . . . . . . . . . . . . 225
David Clark and Peter John Ashton Hutchinson
20.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
20.2 Neurosonology in Neurological Infections in the Tropics . . . 226
20.3 Human Immunodeciency Virus . . . . . . . . . . . . . . . . . . . . . . 226
20.4 Tuberculous Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
20.4.1 Intracranial Hypertension in TBM . . . . . . . . . . . . . . 227
20.4.2 Tuberculous Meningitis- Related Vasculopathy . . . . 227
20.5 Cryptococcal Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
20.5.1 Intracranial Hypertension in CrM . . . . . . . . . . . . . . 229
20.5.2 Vasculopathy in CrM . . . . . . . . . . . . . . . . . . . . . . . . 229
20.6 Neurocysticercosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
20.6.1 Intracranial Hypertension in Neurocysticercosis . . . 230
20.6.2 Vasculopathy in NCC . . . . . . . . . . . . . . . . . . . . . . . . 230
20.7 Cerebral Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
20.7.1 Raised Intracranial Pressure in Paediatric CM . . . . 231
20.7.2 Transcranial Doppler in Paediatric CM . . . . . . . . . . 232
20.8 Neurosonology in Non- infectious Diseases in
Tropical Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
20.8.1 Sickle Cell Anaemia . . . . . . . . . . . . . . . . . . . . . . . . . 234
20.8.2 Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
20.8.3 Traumatic Brain Injury. . . . . . . . . . . . . . . . . . . . . . . 234
20.9 Implementation of Neurosonology in Health Systems in
Low- and Middle- Income Countries . . . . . . . . . . . . . . . . . . . 235
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Part VII Pathology and Clinical Applications:
Specic Considerations
21 Pediatric Population (Pathology and Clinical Applications:
Specific Considerations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Llewellyn C. Padayachy
21.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
21.2 Diagnostic Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
21.2.1 Transcranial Doppler Sonography (TCD) . . . . . . . . 244
21.2.2 Transorbital Imaging . . . . . . . . . . . . . . . . . . . . . . . . 244
21.2.3 Transcranial Imaging . . . . . . . . . . . . . . . . . . . . . . . . 245
21.3 Image-Guided Therapeutic Interventions . . . . . . . . . . . . . . . 246
21.4 Intraoperative Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
22 Brain Ultrasound in the Critically Ill Pregnant
and Puerperium Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Pablo Blanco and Anselmo Abdo-Cuza
22.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
22.2 Brain Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
xviii
22.3 Normal Cerebral Physiology in Pregnancy . . . . . . . . . . . . . . 250
22.4 Unique Brain Diseases of Pregnancy and Puerperium . . . . . 251
22.4.1 Preeclampsia and Eclampsia . . . . . . . . . . . . . . . . . . 251
22.4.2 Postpartum Angiopathy . . . . . . . . . . . . . . . . . . . . . . 254
22.4.3 Cerebral Venous Sinus Thrombosis . . . . . . . . . . . . . 254
22.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Part VIII Pathology and Clinical Applications: Intraoperative
Applications
23 Intraoperative Application of Brain Ultrasound in
Non-cardiac Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Rita Bertuetti
23.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
23.2 Techniques and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
23.2.1 Assessment of CBF: TCD and TCCD . . . . . . . . . . . 260
23.2.2 Estimation of CPP and ICP . . . . . . . . . . . . . . . . . . . 261
23.2.3 Embolism Detection. . . . . . . . . . . . . . . . . . . . . . . . . 261
23.3 Clinical Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
23.3.1 Vascular Surgery: Carotid Endarterectomy . . . . . . . 264
23.3.2 Pneumoperitoneum and Prone Position . . . . . . . . . . 265
23.3.3 Beach Chair Position and Orthopaedic Surgery . . . 266
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Contents
24 Cardiac Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Massimo Lamperti, Amit Jain, and Vinay Byrappa
24.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
24.2 Basic POCUS-B in Cardiac Surgery . . . . . . . . . . . . . . . . . . . 270
24.3 Brain Ultrasound Monitoring in Paediatric
Cardiac Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
24.3.1 Usefulness of Preoperative Brain
Ultrasonography in Paediatric Cardiac Surgery . . . . 271
24.3.2 Usefulness of Intraoperative Brain
Ultrasonography in Paediatric Cardiac Surgery . . . . 271
24.4 Brain Ultrasound Monitoring in Adult Cardiac Surgery . . . . 273
24.4.1 Preoperative Transcranial Doppler . . . . . . . . . . . . . . 273
24.4.2 Intraoperative Use of Transcranial Doppler . . . . . . . 274
24.5 Multimodal Neurologic Monitoring in Cardiac Surgery . . . . 278
24.6 Limitations of Transcranial Doppler in Cardiac Surgery . . . . 278
24.7 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Contents
xix
Part IX Clinical Cases
25 Case 1: Vasospasm Treated with Intra-Arterial Nimodipine . . . 285
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
26 Case 2: Vasospasm Treated with Ballooning Angioplasty . . . . . . 289
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
27 Case 3: Vasospasm Treated with Ballooning Angioplasty . . . . . . 295
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
28 Case 4: aSAH during Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
29 Case 5: Intracranial Hypertension and Decompressive
Craniectomy in Severe aSAH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
30 Case 6: Brain Ultrasound for EVD Weaning . . . . . . . . . . . . . . . . 309
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
31 Case 7: Posterior Cranial Fossa Brain Tumor
in a Pediatric Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
32 Case 8: Cerebral Circulatory Arrest . . . . . . . . . . . . . . . . . . . . . . . 317
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
33 Case 9: Intracranial Hypertension and Hydrocephalus . . . . . . . 319
Rita Bertuetti, Nicola Zugni, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
xx
34 Case 10: Intracranial Hypertension and Decompressive
Craniectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Rita Bertuetti, Nicola Zugni, Maurizio Saini,
Davide Savo, Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
35 Case 11: Hydrocephalus with Ventricular Vegetations . . . . . . . . 325
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
36 Case 12: Intracranial Hypertension after Ischemic Stroke . . . . 327
Rita Bertuetti, Maurizio Saini, Davide Savo,
Francesca Simonassi, Kartika Chandrapatham,
and Tarek Senussi
Contents
List of Videos
Video 4.1 Optic nerve sheath diameter measurement using ocular
sonography in the horizontal and vertical axes
Video 17.1 TCCD, transtemporal approach, midbrain plane. In the trans-
temporal approach, the midbrain plane is recognizable for its
typical buttery-shaped hypoechogenic structure surrounded by
the hyperechogenic basal cisterns. By tilting the probe above the
midbrain of 10°, the thalamic plane with the third ventricle is
visualized
Video 17.2 TCCD, transtemporal approach, midbrain plane. Typical vascu-
lar representation in color-mode pattern of the midbrain plane
where the ipsilateral MCA M1–M2 segments and ACA-A1 are
visualized; also contralateral ACA-A1 and MCA-M1 may be
visible. Note the optimal quality of the temporal window. By
tilting the probe above the midbrain of 100, the thalamic plane
with the third ventricle is visualized. In this plane are typically
visible the PCA-P2 segment, the distal part of ACA-A2, and
MCA-M2. By lowering the insonation angle by 10° from the
midbrain plane, the upper pontine plane is displayed. Here, the
distal ICA is recognized as well as the PCA-P1 segment (also
partially visible in the midbrain plane)
Electronic Supplementary Material is available in the online version
oftherelated chapter on https://doi.org/10.1007/978-3-030-48202-2_4 and
https://doi.org/10.1007/978-3-030-48202-2_17.
xxi
Part I
Technology, Views and Normal Echo
Anatomy