الفهرس 
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Abstract
Traumatic brain injury (TBI) is a significant worldwide healthcare and economic issue. This problem impacts individuals from different ages and is common in both societies with high and low income
TBI can result from different processes, such as road traffic accidents, fall from height, and assaults, and it can have short-term together with long-term serious clinical effects, such as mortality and dysfunction.
TBI can be categorized according to a number of factors, such as the type, extent, site, mechanism, and body’s response to the injury. It is commonly classified into primary impact and secondary cerebral damage (e.g., hypoxia and hypotension), which has an impact on the course of treatment and the neurological recovery following TBI. Cerebral blood flow (CBF) is reduced and close to the ischemic threshold right post TBI. Modern TBI management points out to the prevention as well as treatment of these secondary injuries. Maintaining appropriate cerebral blood flow (CBF) is crucial in this situation. However, it is difficult to evaluate the variations in CBF in real time at the bedside during therapeutic intervention, and imaging methods like perfusion computed tomography (CT) scan and perfusion magnetic resonance imaging (MRI) cannot be used routinely to achieve this.
Transcranial Doppler (TCD) is a simple maneuver that have the ability to measure real-time (CBF-V) in the major intracranial arteries. Through comparatively thin bone windows, low-frequency US waves are used to insonate the basal cerebral arteries. TCD enables high temporal resolution dynamic monitoring of vessel pulsatility and CBF-V over prolonged periods of time. Compared to other imaging modalities, it is more convenient due to its portability, repeatability, and relative affordability—a feature that is especially helpful in emergency situations.
This is a prospective cohort study which was applied on 55 adult individuals of both sexes who fulfilled the inclusion as well as exclusion criteria and were consecutively admitted to the Emergency Department in Helwan university hospital. The study’s objective was to evaluate the predictive ability of Transcranial Doppler in the early detection of neurologic outcomes in cases suffering from TBI.
Initial clinical assessment of all enrolled patients was done. Detailed history including mechanism and time of injury, physical examination including vital signs and GCS score was recorded on admission.
(CT) scans of the head on admission was done and classified according to Rotterdam and Marshal CT classification models.
TCD was carried out within the first 8 hours post traumatic and repeated after 6 hours. The 2MHz ultrasound probe was used over the temporal area. Tracings of right and left middle cerebral arteries were done and by using pulsed wave on the visualized segment, the peak systolic (PSV), end diastolic (EDV) velocities were measured and mean flow velocity (MFV) was calculated using the formula: (PSV+ (EDVx 2)/3. Pulsatility index (PI) was also calculated using the formula: (PSV-EDV)/ MFV.
The outcome measures were; secondary neurological deterioration (SND) at day 7 after trauma and in-hospital mortality.
Studied patients were classified into two primary outcome groups, who were developed SND; 19 cases (34.5%) and who didn‘t developed SND; 36 cases (65.4%), at day 7 after trauma.
Significantly higher Rotterdam and Marshal CT scores on admission are noted at the group developed SND (p value of <0.001).
Based on TCD measurements recorded within 8 hours after trauma, patients with SND had significantly lower ED and MF velocities (p value <0.001 and 0.004 respectively), and higher PI (p value of <0.001). However PSV showed no significant variation.
As regards in-hospital mortality only 4 cases died (5%), of the TCD measurements the PI and EDV showed significant difference between died and survived groups. PI was higher in the dead cases with p value < 0.001 while the EDV was significantly lower at the died group with P value 0.0277
Accordingly TCD measurements obtained early upon admission could be useful predictors for neurological outcomes in TBI and might be of value if added in the multimodality monitoring of TBI not only for severe but also in mild and moderate cases.