TRANSCRANIAL DOPPLER MONITORING IN HEAD-INJURY - RELATIONS BETWEEN TYPE OF INJURY, FLOW VELOCITIES, VASOREACTIVITY, AND OUTCOME

EIGHTY-SIX PATIENTS WITH head injuries with an admission Glasgow Coma Scale score between 3 and 12 were studied sequentially by transcranial and cervical Doppler sonography. On a subset of 26 patients, sequenti al autoregulation and CO2 reactivity testing was also performed. Patie nt characteristics and hemodynamic data were correlated and analyzed w ith respect to the final outcome. The internal carotid artery (ICA) an d middle cerebral artery flow velocities followed a typical pattern. B oth were depressed during the first 3 days after the trauma and then i ncreased to a maximum between Days 5 and 7. The increase of the middle cerebral artery flow velocities was more pronounced than the increase of the ICA flow velocities, thus indicating some degree of vasospasm. The amount of subarachnoid hemorrhage on the initial computed tomogra phy correlated with the average middle cerebral artery/ICA flow veloci ty ratio (r = 0.5). Subarachnoid hemorrhages on computed tomography an d, to a lesser degree, subdural and intracerebral hematomas were corre lated with an unfavorable outcome. Vasospasm remained subcritical, and no negative relationship to outcome could be identified. Hyperperfusi on, as based on ICA flow velocities, and vasospasm were correlated wit h diminished vasoreactivity. However, disturbed vasoreactivities, part icularly during the first days, were common and did not necessarily pr edict an unfavorable outcome.