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Transcranial Doppler Examination on Head Injuries Patient : Its Used on Detection of Hyperemi Condition (Pemeriksaan Doppler Transkranial (TCD) pada Penderita Cedera Kepala Berat: Manfaatnya dalam Mendeteksi Keadaan Hiperemi)
Acute cerebrovascular congestion after a closed head injury is significantly related to intracranial hypertension and bad prognosis. As an indirect method of cerebral blood flow measurement, Transcranial Doppler (TCD) Sonography provides a rapid and invasive assessment of cerebral haemodynamics, including hyperaemic conditions. TCD examinations was serially performed in 35 patients with severe head injury with intact cerebral circulation; i.e. the mean flow velocity (MFV) of the middle cerebral artery (MCA) did not show any signs of cerebral circulatory arrest such as systolic spike, to and fro, or no flow. The result showed that the MFV of the MCAs and ipsilateral extracranial carotid arteries (ICAs) in 9 of these patients increased sharply, and pulsatility index (PI) decreased during 48-96 hours after the injury. This was soon followed by patterns of high intracranial resistance, consistent with elevated intracranial pressure (ICP) in monitored patients and acute cerebral swelling on repeated computed tomographic (CT) scans. The correlation between increased MFVs, decreased Pls, and cerebral haemodynamic changes leading to acute cerebral swelling is discussed. The number of patients who ended with severe disability, vegetative state, or death was 66 percent in this group of 9 patients, compared to only 34 percent for the overall 35 patients with severe head injury. Though the morbidity and mortality rates largely depend on the primary injury, the presence of acute cerebral swelling aggravete the grave course in these patients. And the ability of TCD to evaluate the hyperaemic state prior to the cerebral swelling should lead us to adjust the therapy in order to minimize the secondary injury related to intracranial hypertension.
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