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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Feb;70(2):198–204. doi: 10.1136/jnnp.70.2.198

Preliminary experience of the estimation of cerebral perfusion pressure using transcranial Doppler ultrasonography

E Schmidt 1, M Czosnyka 1, I Gooskens 1, S Piechnik 1, B Matta 1, P Whitfield 1, J Pickard 1
PMCID: PMC1737197  PMID: 11160468

Abstract

OBJECTIVE—The direct calculation of cerebral perfusion pressure (CPP) as the difference between mean arterial pressure and intracranial pressure (ICP) produces a number which does not always adequately describe conditions for brain perfusion. A non-invasive method of CPP measurement has previously been reported based on waveform analysis of blood flow velocity measured in the middle cerebral artery (MCA) by transcranial Doppler. This study describes the results of clinical tests of the prototype bilateral transcranial Doppler based apparatus for non-invasive CPP measurement (nCPP).
METHODS—Twenty five consecutive, paralysed, sedated, and ventilated patients with head injury were studied. Intracranial pressure (ICP) and arterial blood pressure (ABP) were monitored continuously. The left and right MCAs were insonated daily (108 measurements) using a purpose built transcranial Doppler monitor (Neuro QTM, Deltex Ltd, Chichester, UK) with software capable of the non-invasive estimation of CPP. Time averaged values of mean and diastolic flow velocities (FVm, FVd) and ABP were calculated. nCPP was then computed as: ABP×FVd/FVm+14.
RESULTS—The absolute difference between real CPP and nCPP (daily averages) was less than 10 mm Hg in 89% of measurements and less than 13 mm Hg in 92% of measurements. The 95% confidence range for predictors was no wider than ±12 mm Hg (n=25) for the CPP, varying from 70 to 95 mm Hg. The absolute value of side to side differences in nCPP was significantly greater (p<0.05) when CT based evidence of brain swelling was present and was also positively correlated (p<0.05) with mean ICP.
CONCLUSION—The device is of potential benefit for intermittent or continuous monitoring of brain perfusion pressure in situations where the direct measurement is not available or its reliability is in question.



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Selected References

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  1. Bergsneider M., Hovda D. A., Shalmon E., Kelly D. F., Vespa P. M., Martin N. A., Phelps M. E., McArthur D. L., Caron M. J., Kraus J. F. Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study. J Neurosurg. 1997 Feb;86(2):241–251. doi: 10.3171/jns.1997.86.2.0241. [DOI] [PubMed] [Google Scholar]
  2. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  3. Chan K. H., Miller J. D., Dearden N. M., Andrews P. J., Midgley S. The effect of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb venous oxygen saturation after severe brain injury. J Neurosurg. 1992 Jul;77(1):55–61. doi: 10.3171/jns.1992.77.1.0055. [DOI] [PubMed] [Google Scholar]
  4. Czosnyka M., Matta B. F., Smielewski P., Kirkpatrick P. J., Pickard J. D. Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography. J Neurosurg. 1998 May;88(5):802–808. doi: 10.3171/jns.1998.88.5.0802. [DOI] [PubMed] [Google Scholar]
  5. Czosnyka M., Smielewski P., Piechnik S., Schmidt E. A., Al-Rawi P. G., Kirkpatrick P. J., Pickard J. D. Hemodynamic characterization of intracranial pressure plateau waves in head-injury patients. J Neurosurg. 1999 Jul;91(1):11–19. doi: 10.3171/jns.1999.91.1.0011. [DOI] [PubMed] [Google Scholar]
  6. Dahl A., Lindegaard K. F., Russell D., Nyberg-Hansen R., Rootwelt K., Sorteberg W., Nornes H. A comparison of transcranial Doppler and cerebral blood flow studies to assess cerebral vasoreactivity. Stroke. 1992 Jan;23(1):15–19. doi: 10.1161/01.str.23.1.15. [DOI] [PubMed] [Google Scholar]
  7. Giller C. A., Hatab M. R., Giller A. M. Oscillations in cerebral blood flow detected with a transcranial Doppler index. J Cereb Blood Flow Metab. 1999 Apr;19(4):452–459. doi: 10.1097/00004647-199904000-00011. [DOI] [PubMed] [Google Scholar]
  8. Jones P. A., Andrews P. J., Midgley S., Anderson S. I., Piper I. R., Tocher J. L., Housley A. M., Corrie J. A., Slattery J., Dearden N. M. Measuring the burden of secondary insults in head-injured patients during intensive care. J Neurosurg Anesthesiol. 1994 Jan;6(1):4–14. [PubMed] [Google Scholar]
  9. Klingelhöfer J., Conrad B., Benecke R., Sander D., Markakis E. Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease. J Neurol. 1988 Jan;235(3):159–162. doi: 10.1007/BF00314307. [DOI] [PubMed] [Google Scholar]
  10. Metz C., Holzschuh M., Bein T., Woertgen C., Rothoerl R., Kallenbach B., Taeger K., Brawanski A. Monitoring of cerebral oxygen metabolism in the jugular bulb: reliability of unilateral measurements in severe head injury. J Cereb Blood Flow Metab. 1998 Mar;18(3):332–343. doi: 10.1097/00004647-199803000-00012. [DOI] [PubMed] [Google Scholar]
  11. Miller J. D., Stanek A., Langfitt T. W. Concepts of cerebral perfusion pressure and vascular compression during intracranial hypertension. Prog Brain Res. 1972;35:411–432. doi: 10.1016/S0079-6123(08)60102-8. [DOI] [PubMed] [Google Scholar]
  12. Nagai H., Moritake K., Takaya M. Correlation between transcranial Doppler ultrasonography and regional cerebral blood flow in experimental intracranial hypertension. Stroke. 1997 Mar;28(3):603–608. doi: 10.1161/01.str.28.3.603. [DOI] [PubMed] [Google Scholar]
  13. Robertson C. S., Narayan R. K., Contant C. F., Grossman R. G., Gokaslan Z. L., Pahwa R., Caram P., Jr, Bray R. S., Jr, Sherwood A. M. Clinical experience with a continuous monitor of intracranial compliance. J Neurosurg. 1989 Nov;71(5 Pt 1):673–680. doi: 10.3171/jns.1989.71.5.0673. [DOI] [PubMed] [Google Scholar]
  14. Rosner M. J., Rosner S. D., Johnson A. H. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg. 1995 Dec;83(6):949–962. doi: 10.3171/jns.1995.83.6.0949. [DOI] [PubMed] [Google Scholar]
  15. Valadka A. B., Gopinath S. P., Contant C. F., Uzura M., Robertson C. S. Relationship of brain tissue PO2 to outcome after severe head injury. Crit Care Med. 1998 Sep;26(9):1576–1581. doi: 10.1097/00003246-199809000-00029. [DOI] [PubMed] [Google Scholar]
  16. Vespa P., Prins M., Ronne-Engstrom E., Caron M., Shalmon E., Hovda D. A., Martin N. A., Becker D. P. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg. 1998 Dec;89(6):971–982. doi: 10.3171/jns.1998.89.6.0971. [DOI] [PubMed] [Google Scholar]
  17. Wolfla C. E., Luerssen T. G., Bowman R. M. Regional brain tissue pressure gradients created by expanding extradural temporal mass lesion. J Neurosurg. 1997 Mar;86(3):505–510. doi: 10.3171/jns.1997.86.3.0505. [DOI] [PubMed] [Google Scholar]
  18. Zurynski Y., Dorsch N., Pearson I., Choong R. Transcranial Doppler ultrasound in brain death: experience in 140 patients. Neurol Res. 1991 Dec;13(4):248–252. doi: 10.1080/01616412.1991.11740000. [DOI] [PubMed] [Google Scholar]
  19. al-Rawi P. G., Smielewski P., Kirkpatrick P. J. Preliminary evaluation of a prototype spatially resolved spectrometer. Acta Neurochir Suppl. 1998;71:255–257. doi: 10.1007/978-3-7091-6475-4_73. [DOI] [PubMed] [Google Scholar]

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