These preliminary data indicate that the use of a transpulmonary ultrasound contrast agent (SH U 508 A) may substantially broaden the spectrum and potential diagnostic utility of transcranial ultrasound by allowing detection of supratentorial peripheral central nervous system arteries, deep cerebral veins, and (through the foramen magnum) the entire vertebrobasilar system, including the cerebellar arteries.

Experience with a continuous-pressure controlled, external ventricular drainage system (EVD) in 100 patients (n = 49 female, n = 51 male; mean age, 56.3 yr) with acute hydrocephalus is reported. Cerebrospinal fluid circulation disturbances resulted from hemorrhages caused by subarachnoid hemorrhage (n = 45), parenchymal hemorrhages from angioma (n = 4), anticoagulants (n = 7), or hypertension or other reasons (n = 30); in addition, hydrocephalus developed from infections (n = 3), tumors (n = 2), infratentorial infarction (n = 5), or unknown reasons (n = 4); 52 patients had ventricular hemorrhages. No patient died of system-associated morbidity. Mean time of EVD treatment was 9.5 days, with 40 patients being treated for 10 to 29 days; routine refobacin (5 mg) flushing of the system was performed three times a day. Patients without cerebrospinal fluid leakage had a 2% rate of secondary infection compared with 13% in patients with cerebrospinal fluid leakage due to ventricular catheter placement (P < 0.05; overall infection rate, 5%). A clinical mortality rate of 29% during EVD treatment was observed in subarachnoid hemorrhage patients (Hunt and Hess Grades II, III, IV, and V; n = 9, 9, 18, and 9, respectively); recurrent hemorrhages during EVD treatment occurred in 19 patients (26 hemorrhages), and of these, 10 patients died. System occlusion was seen in 19 cases (12 of 45 patients with subarachnoid hemorrhage), requiring catheter and system renewal in 1 case; system extraction was seen in 3 cases, misplacement was seen in 11 cases, and disconnection was seen in 5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Transcranial color-coded real-time sonography (TCCS) was applied to 26 patients with ventricular enlargement to quantify the ventricular size and to estimate intracranial pressure. Intracranial pressures, as determined by lumbar, epidural, or ventricular tonometry, ranged from 6.5 to 55 cm H2O (8 patients had pressures > 18 cm H2O). The widths of the third ventricle and the frontal horns of both lateral ventricles depicted by TCCS were compared to corresponding computed tomography data: TCCS and computed tomography findings correlated well for the third ventricle (r = 0.96) and for the right (r = 0.86) and left (r = 0.92) frontal horns. The capability of the septum pellucidum to undulate relative to the ventricular wall during short (20-degree) rotatory movements of the head was related to intracranial pressure. In all patients with intracranial pressure below 17 cm H2O, rotatory head movements induced septum pellucidum undulation; no lateral deflection of the septum pellucidum was found in patients with an intracranial pressure above 21 cm H2O. Therefore, TCCS may be employed to quantify and follow-up ventricular enlargement. Dynamic neurosonographic tests may allow a gross estimation of intracranial pressure.

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