Transcranial Doppler Studies

Description

1. Transcranial Doppler (TCD) ultrasonography involves

noninvasive testing to measure flow changes in the form of

velocities of the cerebral arteries. It helps evaluate vasospasm

post-SAH, occlusion, or flow abnormalities as with stroke.

2. Bone windows (temporal, transorbital, or foramen magnum)

are accessed using a fiber-optic probe after application of

ultrasound gel. The fiber-optic probe is directed at a specific

artery, and the velocities are then recorded.

3. Specific criteria are utilized for identification of each cerebral

vessel prior to assessment of the vessel (specific bone window,

depth, flow direction, and waveform).

4. Advantages of TCD studies: Low cost; can be performed at

bedside and repeated as needed (useful in monitoring trends).

5. Disadvantages of TCD studies: Results are operator dependent; inability to obtain signal; limited data
on sensitivity and

specificity.

Nursing and Patient Care Considerations

1. Explain that the study will be done with patient in a reclining

position.

2. Inform patient that the test normally takes less than 1 hour,

depending on the number of arteries that are to be studied.

CT Perfusion

Description

1. CT perfusion involves rapid injection (5 to 10 mL/second) of

40 mL of iodine contrast during continuous scanning. Computer analysis of “wash-in” and “wash-out” of
the contrast

generates a single-slice acquisition blood flow map.

2. The test requires a large-bore catheter (14 or 16 gauge) for

injection of the contrast. Contrast is cleared through the

kidneys; therefore, renal function should be evaluated prior

to study to reduce the risk of contrast-induced nephropathy

3. CT scan is programmed to analyze specific area of concern.

Three 1-cm thick computer-generated images are produced

that reflect relative cerebral blood flow, relative blood volume,

and mean transit time.

4. Advantages of CT perfusion: 90% sensitivity and 100% specificity for cerebral ischemia; can be
performed in conjunction with CT angiogram. Can be used in evaluating cerebral

vasospasm in aneurysmal SAH, though the sensitivity and

specificity is unknown.

5. Disadvantages of CT perfusion: Limited anatomic assessment;

radiation exposure; if contrast is used there is the risk of

contrast-induced nephropathy; requires large-bore catheter.

Nursing and Patient Care Considerations

1. Instruct patient about the rationale for placement of largebore catheter.

2. Assess patient for contrast allergy and premedicate, if indicated.

3. Inform patient that radiation exposure, although present, is

minimal.