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Intracerebral Hematomas, Midline Shift, Hydrocephalus

Abstract:

Cerebral ultrasonography has been increasingly used in patients with hemorrhagic stroke to evaluate brain hemodynamics, as well as pathological findings such as the mass effect of intracerebral hematomas. Transcranial color-coded duplex (TCCD) sonography is a noninvasive, bedside tool that aids in the estimation of the hematoma volume and can accurately identify early expansion in follow-up examinations. TCCD also allows clinicians to monitor the midline shift at the bedside in patients with suspected intracranial hypertension and high risk of neurological deterioration. Additionally, other less common applications of bedside ultrasound have been explored in neurocritical patients such as the evaluation of hydrocephalus, subdural hematomas, and cerebral venous drainage. In this chapter we examine the data that supports the clinical use of brain ultrasound in the ICU, as well as discuss how to integrate this noninvasive tool to our daily management of patients.