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The Prediction of Intracranial Pressure and Clinical Outcome by Transcranial Doppler in Neurocritical Patients

16 Years
80 Years
Open (Enrolling)
Head Injury, Intracerebral Hemorrhage, Ischemic Stroke, Subarachnoid Hemorrhage, Brain Tumor, Hydrocephalus

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Trial Information

The Prediction of Intracranial Pressure and Clinical Outcome by Transcranial Doppler in Neurocritical Patients

Transcranial Doppler (TCD) and Transcranial color-coded duplex sonography (TCCS) play an
important part in neurocritical monitoring systems. Currently there are studies using flow
velocities and pulsatility index (PI) to predict intracranial pressure (ICP) and clinical
outcome. But the use of B-mode in such prediction is not yet investigated. The purposes of
this study are to establish the correlation among clinical data, CT findings and information
collected by TCCS, and to predict ICP and neurological outcome using such information. The
focus would be on 3rd ventricle size, midline shift and anteroposterior-transverse ration of
midbrain (midbrain index) obtained by B-mode of TCCS. This study is a prospective clinical
study targeting on 30 neurocritical patients admitted to intensive care units in one year.
The timing of performance of TCCS will be (1) within 6 hours after admission, (2) within 6
hours after each CT examination, and (3) when ICP is higher than 20 mmHg for more than 5
minutes. Glasgow coma scale (GCS), heart rate, blood pressure (systolic, diastolic, and
mean), body temperature, central venous pressure (CVP), brain temperature, ICP, cerebral
perfusion pressure (CPP), mean velocity (MV) of bilateral middle cerebral arteries (MCAs),
PI, midline shift, 3rd ventricular dimension, anteroposterior to transverse ratio of
midbrain (midbrain index, MI) are recorded. The latter three parameters are also obtained
from CT scans, and compared with those obtained from TCCS. Outcome is evaluated with
extended Glasgow outcome scale (GOSE), and analyzed with previous records. This study is
going to prove that TCCS is a safe, convenient, real-time and cheap tool in clinical care
for neurocritical patients. It also provides prediction of ICP and clinical outcome.

Inclusion Criteria:

- Aged 16 to 80 years

- Neurocritical patient (head injury, hemorrhagic or ischemic stroke, subarachnoid
hemorrhage, etc.) who was admitted to intensive care unit and had undergone
intracranial pressure monitoring

Exclusion Criteria:

- associated with multiple organ impairment or failure

- single organ failure prior to neurocritical condition, such as cardiac, hepatic, or
renal failure

- associated with severe infection or sepsis

Type of Study:


Study Design:

Observational Model: Cohort, Time Perspective: Prospective

Principal Investigator

Yi-Hsin Tsai, M.D.

Investigator Role:

Principal Investigator

Investigator Affiliation:

Department of Traumatology, National Taiwan University Hospital


Taiwan: Department of Health

Study ID:




Start Date:

December 2009

Completion Date:

December 2010

Related Keywords:

  • Head Injury
  • Intracerebral Hemorrhage
  • Ischemic Stroke
  • Subarachnoid Hemorrhage
  • Brain Tumor
  • Hydrocephalus
  • Transcranial Doppler
  • Transcranial color-coded duplex sonography
  • Neurocritical patients
  • Brain Neoplasms
  • Craniocerebral Trauma
  • Hemorrhage
  • Hydrocephalus
  • Stroke
  • Subarachnoid Hemorrhage
  • Cerebral Hemorrhage