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25.04.2019 | Review | Ausgabe 7/2019

Intensive Care Medicine 7/2019

Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review

Intensive Care Medicine > Ausgabe 7/2019
Chiara Robba, Alberto Goffi, Thomas Geeraerts, Danilo Cardim, Gabriele Via, Marek Czosnyka, Soojin Park, Aarti Sarwal, Llewellyn Padayachy, Frank Rasulo, Giuseppe Citerio
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00134-019-05610-4) contains supplementary material, which is available to authorized users.
Frank Rasulo and Giuseppe Citerio contributed equally to this article

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Brain ultrasonography can be used to evaluate cerebral anatomy and pathology, as well as cerebral circulation through analysis of blood flow velocities. Transcranial colour-coded duplex sonography is a generally safe, repeatable, non-invasive, bedside technique that has a strong potential in neurocritical care patients in many clinical scenarios, including traumatic brain injury, aneurysmal subarachnoid haemorrhage, hydrocephalus, and the diagnosis of cerebral circulatory arrest. Furthermore, the clinical applications of this technique may extend to different settings, including the general intensive care unit and the emergency department. Its increasing use reflects a growing interest in non-invasive cerebral and systemic assessment. The aim of this manuscript is to provide an overview of the basic and advanced principles underlying brain ultrasonography, and to review the different techniques and different clinical applications of this approach in the monitoring and treatment of critically ill patients.

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Video demonstrating TCCD examination and vessels insonation (MP4 18745 kb)
Video demonstrating how to perform ONSD examination (MP4 17572 kb)
Changes in the middle cerebral artery waveform morphology during progressive increase of ICP and decrease in CPP. When ICP equalizes to diastolic blood pressure, cerebral blood flow is only detected during systole. If ICP reaches values greater than diastolic blood pressure, an oscillatory movement of blood with reversal of diastolic flow appears. When ICP reaches the systolic blood pressure, only sharp systolic spikes are evident (reverberating flow), indicating the absence of any net forward flow (i.e., absence of cerebral blood supply) compatible with cerebral circulatory arrest (MP4 24921 kb)
Figure demonstrating the use of point-of-care ultrasound in the context of cardiac arrest. Brain ultrasonography can be implemented as part of the whole-body sonographic assessment of patients suffering cardiac arrest for resuscitation guidance or for monitoring in the post-cardiac arrest management (MOV 4015 kb)
Supplementary material 19 (MOV 8283 kb)
Supplementary material 20 (MOV 7436 kb)
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