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Title: The clinical application of transcranial Doppler ultrasonography in infants and children
Author: Goh, Day-Eel
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1996
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Transcranial Doppler ultrasound (TCD) is a non-invasive, safe and readily repeatable technique of measuring cerebral blood flow velocity (CBFV) which may be ideally suited for the bedside assessment of cerebrohaemo-dynamic changes in children. A number of clinical conditions in which this technique could yield useful information was investigated i.e in infants and children with hydrocephalus, pyogenic meningitis and during cardiopulmonary bypass (CPB) surgery. A range of normal CBFV values was first established from 51 normal children. Data on the peak-systolic (PSV), end-diastolic (EDV), mean flow (MFV) velocities and the Pourcelot Resistance Index (RI) was obtained in all TCD examinations. The RI is a ratio of the (PSV-EDV)/EDV. Where clinically indicated direct simultaneous measurements of intracranial pressure (ICP) was also performed to relate the observed changes in CBFV to ICP changes. In normal children after infancy, the RI remains stable throughout childhood while the MFV, PSV and EDV values are relatively stable over the first decade but decrease in the second decade of life. In the hydrocephalic patients a reduction in ICP with CSF drainage was associated with a decreased RI due to an increase in EDV which suggests that the RI reflects changes in distal cerebrovascular resistance. There was a significant correlation between RI and ICP in patients outwith infancy and in individual young infants. The RI was a reliable index for assessment and monitoring purposes. Volume-flow velocity response studies during CSF taps suggest there is an exponential relationship between RI and CSF volume drained. The sleep study results suggest that some patients are able to haemodynamically compensate during episodes of raised ICP while patients with a decreased MFV response may be at greater risk with inadequate haemodynamic compensation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available