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Transcranial sonography is a common tool for monitoring neurocritical patients. Transcranial color-coded duplex ultrasonography enables hemodynamic and structural study of the cerebral parenchyma in these patients. Its advantages over conventional ultrasonography are evident and are derived from direct visualization of the vessel to be studied and appropriate adjustment of the sample volume and angle of insonation. The use of ultrasonographic contrast agents enables conclusive findings in practically 100% of cases and allows cerebral perfusion to be studied at the bedside using semiquantitative methods. This review aims to show the applications of transcranial color-coded duplex ultrasonography for monitoring neurocritical patients in intensive care units.

Objective: To compare the number of vessels identified and mean velocity and pulsatility index values obtained by transcranial doppler (TCD) and transcranial color coded sonography (TCCS) in patients with traumatic brain injury (TBI)., Methods: Thirty patients suffering from TBI admitted in our neurocritical Intensive Care Unit (ICU) were studied. We performed consecutive studies by TCD and TCCS. The number of Circle of Willis vessels insonated and the hemodynamic parameters were compared., Results: Mean age was 50 years. Twenty patients were male. By using TCCS, internal carotid artery was insonated in 95%, middle cerebral artery (MCA) in 95%, anterior cerebral artery (ACA) in 91% and posterior cerebral artery (PCA) in 92% of the studies. Using conventional TCD they were insonated in 29%, 93% 67% and 35% of the studies respectively. Mean velocity values measured by CCS and TCD in MCA were 79 cm/sec vs 59 cm/sec respectively (p< 0.0001), in ACA were 61 cm/sec vs 42 cm/sec (p< 0.0001) and in PCA were 43 cm/sec vs 33 cm/sec (p< 0.0001)., Conclusion: TCCS allows a high quality hemodynamic study of TBI patients admitted to the ICU. Further studies must define its impact on outcome of TBI patients.

Posttraumatic carotid-cavernous fistula (PtCCF) is an uncommon complication after cranioencephalic trauma. It is usually diagnosed with a cerebral arteriography when the clinical symptoms have already appeared. The transcranial color-coded duplex sonography (TCDS) is a non-invasive technique at the patient's bedside that permits visualization of the circle of Willis and the intracavernous segment of the internal carotid artery. The initial sonographic patterns that suggest the presence of a PtCCF by TCDS are a mosaic image in color mode, presence of arterial and venous flows mixed with high velocity and low resistances. We present our experience in the early and non-invasive diagnosis of PtCFF in an Intensive Care Unit.

Objective: Transcranial color-coded duplex sonography (TCCDS) is a non invasive bedside technique that allows the determination of midline shift (MLS). The purpose of our study was to compare MLS measurements using TCCDS with those obtained with cranial computerized tomography (CT) in patients with traumatic brain injury (TBI)., Design: Prospective study., Settings: Intensive care unit in a university hospital., Patients: Forty-one traumatic brain-injured patients (35 men and 6 women)., Interventions: A total of 60 studies were conducted with a time interval between the cranial CT and the TCCDS studies of 322+/-216 min., Results: The coefficient of correlation between MLS measured by CT and TCCDS was 0.88, the bias was 0.12 mm, the precision was 1.08 mm and the limits of agreement were +2.33 to -2.07 mm. There were no statistically significant differences in MLS measured by the two techniques in terms of: sex, age or type of lesion according to the Traumatic Coma Data Bank classification., Conclusion: The TCCDS is a non-invasive bedside technique that is valid for determining MLS in patients with traumatic brain injury. Due to the risks involved in the transportation of traumatic brain-injured patients to the radiology department, this bedside technique is specially interesting in these patients.