Hypoflow and hyperflow in diffuse axonal injury. Prognostic and therapeutic implications of transcranial Doppler sonography evaluation.

BACKGROUND: In the present report we describe the results of a study aimed at evaluating the cerebral haemodynamics and the neuroradiological findings observ-ed in 7 consecutive patients, 4 adults and 3 children (6, 8 and 10 years old), affected by diffuse axonal injury (DAI).

METHODS: All the patients were admitted to the Paediatric or Adult Intensive Care Unit with GCS scores less than 8 after a severe brain injury. Serial head CT scan and trans-cranial Doppler sonography (TCD) examinations were carried out in all patients; MRI was carried out in the paediatric patients only. TCD of the middle cerebral arteries was performed through the temporal bone window. In 6 cases (2 paediatric) diuretic osmotic therapy was immediately administered and in 6 cases (3 paediatric) barbiturates and hyperventilation were also used.

RESULTS: Hyperflow, variably responsive to barbiturate therapy of vasoparalysis, was observed in all paediatric patients and in 3 adult subjects (85.7%: 6 out of 7 pa-tients) by means of TCD.

CONCLUSIONS: Observation of these phenomena allowed us to modify the pharmacological treatment and/or perform external cerebrospinal fluid (CSF) drainage (4 cases). Compartimental hyperflow TCD pattern was evident in 1 patient. Although the limited number of patients in our series does not allow definitive conclusions, we strongly believe that TCD monitoring is an useful tool in planning surgical strategy in patients with DAI.