Identification of intracranial hemorrhage progression by transcranial point-of-care ultrasound in a patient with prior hemicraniectomy: a case report

Shah, Aalap; Oliva, Cynthia; Barnes, Ryan M; Presley, Bradley C.

doi:10.1007/s40477-021-00588-6

Cited by 2 publications

(4 citation statements)

References 18 publications

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“…Many authors have described several intracranial windows for ultrasound, but they are rarely performed (6). Transcranial POCUS in a hemicraniectomy patient provides a unique window for evaluating various pathologies which has been reported to identify important intracranial pathologies (13,17).…”

Section: Discussionmentioning

confidence: 99%

“…Transtemporal windows is another commonly performed window for the evaluation of vasospasm of cerebral arteries. Owing to an open fontanelle and thinner transtemporal window in neonates and infant, the imaging has shown to be highly sensitive and specific to that of an adult hemicraniectomy patient (6). Although, authors have often reported the window to difficult, time consuming and inadequate in adults (18), TCD in aneurysmal subarachnoid hemorrhage, however, has shown to be an important modality for monitoring of vasospasm (8).…”

Section: Discussionmentioning

confidence: 99%

“…Although, POCUS in neurosurgical ICUs can never replace gold standard imaging modalities, it can be a useful tool to increase potential ability while using fewer resources (6). POCUS is becoming increasingly popular, with many authors strongly suggesting to add POCUS to the ICUs (17) and to train the neurosurgical residents eventually leading to the betterment of patient care.…”

Section: Discussionmentioning

confidence: 99%

“…POCUS has been shown to be a superior imaging option than conventional imaging technique in emergency and critical care setting by minimizing mobilization, reducing cost, assist in invasive procedures and assess the condition in real time (1)(2)(3). Various authors have used POCUS in different ways for independent brain pathologies (4)(5)(6)(7)(8)(9)(10)(11). However, it is not being routinely used in neurosurgical intensive care unit (ICU) due to steep learning curve and confusion with which modality to use.…”

Section: Introductionmentioning

confidence: 99%

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Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Pokhrel¹,

Thapa²

2023

Quant Imaging Med Surg

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Background: Point of care ultrasound (POCUS) is a cost-effective, non-invasive procedure with high diagnostic reliability and therapeutic utilities. For various reasons, it is not being used routinely in neurosurgical intensive care unit (ICU). We have introduced a systematic use of POCUS in critically ill patients in our neurosurgical ICU. We have studied the various indications and benefit of using this technique.Methods: This is a prospective, single center cohort observational study done in patients who were admitted in a tertiary neurosurgical ICU over 1 year (17 th September 2020 to 16 th September 2021).POCUS was used daily as per a standardized format for multiple purposes. A formal training to the operator was provided and standardized method of evaluation and intervention was used. Outcome was studied to understand the impact of the POCUS and difficulties encountered during its use.Results: POCUS was used in 240 patients, including all patients for primary and secondary surveys, 192 patients (80%) for optic nerve sheath diameter (ONSD) measurement, 14 myelomeningoceles for transfontanelle ultrasound study, 16 post operative cases of aneurysm clipping for transcranial Doppler (TCD) study, 86 patients for deep vein thrombosis (DVT) screening, 17 for evaluation of ventriculo-peritoneal (VP) shunt functionality, 30 for transcranial defect ultrasound, 45 for chest ultrasound, 4 for evaluation of hemodynamic shock and 67 patients who had difficult cannualtion or while insertion of central venous catheter placement. POCUS was also used for difficult cannulation, central catheter placement and e-FAST scan. Significant findings were reported 129 times, which led to immediate change in management in 62 patients (25.83%) as compared to 16 patients in whom significant findings were not reported using POCUS, but management was changed using other radiological modalities (P<0.01). There was initial lag in adopting the technique, however with practice, the team developed confidence. As a result, the accuracy and time taken to perform the procedure was reduced significantly.Conclusions: Routine systematic use of POCUS can be beneficial not only for the rapid diagnosis and prompt management of patients, but also helpful in monitoring and performing various procedures in neurosurgical ICU. Though not all modalities mentioned in standardized format was used in all patients, use of this format has helped improved training and maintain proper use of POCUS in our ICU.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Pokhrel¹,

Thapa²

2023

Quant Imaging Med Surg

View full text Add to dashboard Cite

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Emerging Treatments for Subarachnoid Hemorrhage

Findlay,

Kundu,

Nelson

et al. 2024

CNSNDDT

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The current landscape of therapeutic strategies for subarachnoid hemorrhage (SAH), a significant adverse neurological event commonly resulting from the rupture of intracranial aneurysms, is rapidly evolving. Through an in-depth exploration of the natural history of SAH, historical treatment approaches, and emerging management modalities, the present work aims to provide a broad overview of the shifting paradigms in SAH care. By synthesizing the historical management protocols with contemporary therapeutic advancements, patient-specific treatment plans can be individualized and optimized to deliver outstanding care for the best possible SAH-related outcomes.

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Identification of intracranial hemorrhage progression by transcranial point-of-care ultrasound in a patient with prior hemicraniectomy: a case report

Cited by 2 publications

References 18 publications

Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Systematic use of point of care ultrasound in neurosurgical intensive care unit: a practical approach

Emerging Treatments for Subarachnoid Hemorrhage

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