Every few years a dissertation comes to the area of clinical application of medical technology which carries us forward as on a magic carpet into new regions of understanding and patient care. This book is such a magic carpet. It brings together, in a clear and incisive fashion, important hemodynamic principles with a simple noninvasive method of application to a part of the cerebral vasculature which has been relatively inaccessible. To the lucky and perceptive person who reads this book, a feeling of excitement and hope for progress is engendered. The diligent application of the potentials of transcranial Doppler ultrasound brings new power to our efforts in understanding the cerebral circulation and the causes, treatment and prevention of cerebrovascular disorders. Merrill P. Spencer, M. D. Director Institute of Applied Physiology and Medicine Seattle, Wash. , July 1986 Acknowledgements I am greatly indebted to Prof. He1ge Nornes, Oslo, who introduced me to the fascinating study of cerebral hemodynamics in the early 1970's and since then continually encouraged my interest in this field. It was through his pioneering work on the cerebral circulation-using peroperative electromagnetic flowmetry and Doppler techniques-that the basis was laid for the noninvasive trans cranial approach to the circle of Willis described in this book. I also gratefully acknowledge the stimulating case discussions with Prof. Peter Huber, Berne, at the very early introduction of trans cranial Doppler, the inspiring exchange of ideas with Dr. Merrill P.

The Second Edition of this highly regarded text provides a current reference source on the clinical and research applications of Transcranial Doppler (TCD) ultrasonography. All of the chapters have been updated to reflect the rapid evolution that has taken place in the field. New information has been included on the increased use of TCD in the operating room, the introduction of contrast media, and the development of new softwares that permit the detection of microemboli.

The measurement of the cerebral circulation in children, particularly in newborns and young infants, has for a long time been high on the list of needs in clinical and scientific pediatrics. The methods available to date have either been too unreliable or unsuitable for use on children. In the course of a research project at the Department of Pediatrics of the Uni versity of Freiburg, Dr. Harald Bode has made the first systematic ex amination of the cerebral circulation of children using transcranial Doppler sonography. Over 500 children with ages between 0 and 18 years were included in this exhaustive study, documenting Doppler measurements in about 3,000 basal cerebral arteries. Basic reference values were obtained which involved adapting the methodology and available equipment to the special re quirements of the pediatrician. Moreover, the influence of biological and physiological factors on these Doppler values has also been considered in addition to those of disease and therapy. The result is an impressive record of the many applications of trans cranial Doppler sonography during childhood. It is not difficult to predict that this methodology will be of lasting value and capable of further de velopment. I hope this book receives the attention it undoubtedly deserves and that the author is able to continue in realizing his fruitful scientific ideas in clinical pediatric practice.

This second edition presents core clinical neuroanesthesia and neurointensive care knowledge in a practical, user-friendly format.

Transcranial Doppler (TCD) ultrasound, first introduced more than a decade ago, has steadily evolved into a dynamic, reliable, reproducible, and practical diagnostic tool. Clinical neuroscientists have found TCD to be an indispensable technique in the management of many types of patients. This book is designed to provide basic instruction in the perfor mance and interpretation of transcranial Doppler ultrasonography for technologists, nurses, and physicians. The information included in the text is critical for the development of a strong knowledge base. It is not intended to be all inclusive, and the TCD novice is likely to use it as the platform upon which to build his/her experience in the application of TCD. This book is organized as a step-guided approach for the performance of TCD, and it includes specific guidelines for interpretation of the TCD save forms. We hope that the reader finds it useful during what we think is the most difficult phase of this technique-the learning curve. John P. McCartney, R.V.T. Kathleen M. Thomas-Lukes, R.N., M.N.

Ultrasound provides a unique diagnostic perspective in cerebrovascular disorders, with extremely high temporal resolution and excellent spatial display of extracranial arteries, brain structures and cerebral vessels. This comprehensive text covers the fundamentals of ultrasound physics, new technology, and clinical applications in all ages. It provides a firm grounding in hemodynamics and describes computational models for study of the cerebral circulation. Extracranial applications in assessing the carotid and vertebral arteries are discussed in detail, as are intracranial Doppler applications in stroke, subarachnoid hemorrhage, arteriovenous malformations, interventional and surgical procedures, and the detection and monitoring of cerebral microembolism. These and other topics, both clinical and technical, are presented by leading authorities in the field, with extensive illustrations, and tables are included for the standardized classification of cerebrovascular diseases based on international consensus conferences. For clinicians and clinical neuroscientists this is the definitive reference text in cerebrovascular ultrasound.

This book clearly explains the basics of cranial ultrasonography in the neonate, from patient preparation through to screening strategies and the classification of abnormalities. The aim is to enable the reader consistently to obtain images of the highest quality and to interpret them correctly. Essential information is provided both on the procedure itself and on the normal ultrasound anatomy. The standard technique is described and illustrated, and emphasis is placed on the value of supplementary acoustic windows. Attention is also drawn to maturational changes in the neonatal brain and to the limitations of cranial ultrasonography. Frequently occurring abnormalities are described and classifications for these abnormalities are provided. A new classification for neonatal cerebellar hemorrhages is introduced. In this third edition, all ultrasound images have beena replaced, reflecting the improvements in image quality. An entirely new chapter is devoted to Doppler ultrasonography. The illustrations have been improved and new illustrations were added. The reader will have access to highly informative videos on the cranial ultrasound procedure, available online via SpringerLink. The compact design of the book makes it an ideal and handy reference that will guide the novice in understanding the essentials of the technique while also providing useful information for the more experienced practitioner.

This textbook addresses the classical use of Transcranial Doppler (TCD) and Transcranial Color-Coded Duplex Sonography (TCCS), focusing on the usefulness of neurological monitoring beyond classical acute brain injuries present in the daily intensive care medical practice. It encompasses a wide range of critical pathologies where neurological impact is part of clinical evolution, offering practical approaches for managing, application and interpretation of neurosonology to assist the physician to making real-time individualized decisions at bedside. It is an academic guide developed and edited by international experts being a very useful resource in daily practice for intensivists, neurologists, neurosurgeons and other specialists involving in critical care.

The aim of this book is to educate and train practitioners in the safe and professional use of diagnostic ultrasound imaging in the visualization and interpretation of various cerebral conditions not only in neurointensive care, but also in the operating room and, in general, cardiothoracic and neurocritical care settings. It is chiefly intended for anaesthetists and intensivists with a basic knowledge of ultrasound physics, but also for neurosurgeons and neurologists. All chapters were coordinated by the Editors, with experiences in hands-on courses on Echography and Doppler of the Brain, and prepared by international experts. The book covers from basic principles to estimation of intracranial pressure and cerebral perfusion. The topics cover emergency department and prehospital brain US as part of POCUS and US multiorgan evaluation to general intensive care, neurointensive care and anesthesia, including special populations as pregnant and children and setting as LMIC. Clinical scenarios complete the book. An innovative and unique guide that equips readers to perform bedside and non-invasive assessments for a range of cerebrovascular diseases.

Featuring contributions from internationally recognized experts in point-of-care sonography, Emergency Point-of-Care Ultrasound, Second Edition combines a wealth of images with clear, succinct text to help beginners, as well as experienced sonographers, develop and refine their sonography skills. The book contains chapters devoted to scanning the chest, abdomen, head and neck, and extremities, as well as paediatric evaluations, ultrasound-guided vascular access, and more. An entire section is devoted to the syndromic approach for an array of symptoms and patient populations, including chest and abdominal pain, respiratory distress, HIV and TB coinfected patients, and pregnant patients. Also included is expert guidance on administering ultrasound in a variety of challenging environments, such as communities and regions with underdeveloped healthcare systems, hostile environments, and cyberspace. Each chapter begins with an introduction to the focused scan under discussion and a detailed description of methods for obtaining useful images. This is followed by examples of normal and abnormal scans, along with discussions of potential pitfalls of the technique, valuable insights from experienced users, and summaries of the most up-to-date evidence. Emergency Point-of-Care Ultrasound, Second Edition is a valuable working resource for emergency medicine residents and trainees, practitioners who are just bringing ultrasound scanning into their practices, and clinicians with many years of sonographic experience.