Transcranial Doppler sonography in fulminant hepatic failure.
نویسندگان
چکیده
UNLABELLED The clinical course of patients with fulminant hepatic failure (FHF) is often worsened by the presence of cerebral edema and endocranial hypertension. In spite of the multiple studies using Transcranial Doppler Sonography (TCDS), few have shown the cerebral blood flow (CBF) pattern among patients with encephalopathy resulting from FHF. OBJECTIVE Our objective was to characterize the CBF pattern in these patients through the use of TCDS to provide therapeutic strategies. METHOD The TCDS pattern was assessed in five patients diagnosed with FHF and compared with a control group who displayed critical neurologic conditions not associated with FHF. Pulsatile index, systolic, diastolic, and mean velocity of the middle cerebral artery were measured. RESULTS The mean age of patients with FHF was 45.4 years. One hundred percent were women, with viral hepatitis as the predominant etiology. A cerebral hypoperfusion pattern was found in 80% of the FHF group and 40% of the control group. In the former group there was no evidence of hyperemia, as there was among 20% of the control group. The mean values of velocity and pulsatile index were 36.6 cm/sec and 2.4, respectively, in the FHF group and 47.8 cm/s and 1.8 in the control group (P=0.268, P=0.402). CONCLUSIONS FHF patients show a predominance of cerebral hypoperfusion pattern with mean velocities lower than normal values and an increased pulsatile index. We recommend that clinicians take appropriate measures to improve cerebral perfusion and avoid hypoxia. Hyperventilation as a first level measure is contraindicated.
منابع مشابه
Hepatic Artery Thrombosis
Hepatic artery thrombosis after liver transplantation is a devastating event requiring emergency retransplantation in most patients. Early clinical signs are often nonspecific. Before duplex sonography (combined real-time and pulsed Doppler) capability was acquired in October 1984, 76% of all transplants in this institution referred for angiography with a clinical suspicion of hepatic artery th...
متن کاملAcute fulminant hepatic failure due to colchicine – a rare manifestation of Gloriosa superba poisoning.
متن کامل
Transcranial doppler sonography diagnostic value for the cerebral flow velocity changes in the interictal phase of classic migraine
Background: An imbalance of the cerebrovascular response during functional activation of the brain has been postulated as a factor in the pathophysiology of migraine. The purpose of this study was to determine the transcranial doppler sonography (TDS) diagnostic value for the cerebral flow velocity changes in the interictal phase of classic migraine. Methods: This study was carried out on 46 pa...
متن کاملUse of Transcranial Doppler for Monitoring Hepatic Encephalopathy
Fulminant hepatic failure (FHF) is an acute and severe disease that can lead to death by the development of encephalopathy. Due to the severe alterations of coagulation that go along with this clinical picture, it may be contraindicated to place a sensor for monitoring intracranial pressure (ICP); it is for this reason that the option of the transcranial doppler (TCD) arises as an auxiliary met...
متن کاملCerebral hemodynamic in patients with major β-Thalassemia using transcranial Doppler sonography
Background: β-thalassemia, a severe form of anemia, is an inherited blood disorder characterized by growth retardation, splenomegaly, and bone abnormalities. Complications related to treatment-induced iron overload also affect the quality of life of patients with major β-thalassemia. Some recent studies indicated cerebral hemodynamic disorders and increased risk of stroke in these patients. The...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Transplantation proceedings
دوره 35 5 شماره
صفحات -
تاریخ انتشار 2003