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Intracranial hemorrhage detected through a craniotomy site with point of care ultrasound.

ABSTRACT: A 60-year-old male presented to the emergency department with acute change in mental status while recovering from a recent hemicraniectomy. During evaluation by the emergency physician, a point-of-care ultrasound (POCUS) was performed using the patient's existing craniectomy site as a sonographic window. Multiple areas of intracranial hemorrhage were visualized on POCUS and head computed tomography scan ultimately requiring urgent neurosurgical intervention. Our case report demonstrates an innovative application of POCUS in the emergency department- setting that has potential to expedite diagnosis and management of life-threatening neurosurgical etiologies, such as hemorrhage and midline shift, in a unique patient population.

SUBMITTER: Zakharchenko S

PROVIDER: S-EPMC8212560 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Intracranial hemorrhage detected through a craniotomy site with point of care ultrasound.

Zakharchenko Svetlana S Hansen Allyson A Ibikunle Aminat A Devasagayaraj Richard R Charles Patrick P

Journal of the American College of Emergency Physicians open 20210618 3

A 60-year-old male presented to the emergency department with acute change in mental status while recovering from a recent hemicraniectomy. During evaluation by the emergency physician, a point-of-care ultrasound (POCUS) was performed using the patient's existing craniectomy site as a sonographic window. Multiple areas of intracranial hemorrhage were visualized on POCUS and head computed tomography scan ultimately requiring urgent neurosurgical intervention. Our case report demonstrates an innov ...[more]

PMID: 34179872

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Project description:BackgroundLimited studies have evaluated the use of ultrasound for detection of intracerebral hemorrhage (ICH) using diagnostic ultrasound Transcranial Doppler machines in adults. The feasibility of ICH detection using Point of care Ultrasound (POCUS) machines has not been explored. We evaluated the feasibility of using cranial POCUS B mode imaging performed using intensive care unit (ICU) POCUS device for ICH detection with a secondary goal of mapping optimal imaging technique and brain topography likely to affect sensitivity and specificity of ICH detection with POCUS.Materials and methodsAfter obtaining IRB approval, a blinded investigator performed cranial ultrasound (Fujifilm, Sonosite® Xporte, transcranial and abdominal presets) through temporal windows on 11 patients with intracerebral pathology within 72 h of last CT/MRI (computed tomography scan/magnetic resonance imaging) brain after being admitted to a neurocritical care unit in Aug 2020 and Nov 2020-Mar 2021. Images were then compared to patient's CT/MRI to inform topography. Inferential statistics were reported.ResultsMean age was 57 (28-77 years) and 6/11 were female. Six patients were diagnosed with ICH, 3 with ischemic stroke, 1 subarachnoid hemorrhage, and 1 brain tumor. The sensitivity and specificity of point of care diagnosis of ICH compared to CT/MRI brain was 100% and 50%, respectively. Mean time between ultrasound scan and CT/MRI was 13.3 h (21 min-39 h). Falx cerebri, choroid calcification and midbrain-related artifacts were the most reproducible hyperechoic signals. Abdominal preset on high gain yielded less artifact than Transcranial Doppler preset for cranial B mode imaging. False positive ICH diagnosis was attributed to intracerebral tumor and midbrain-related artifact.ConclusionsOur exploratory analysis yielded preliminary data on use of point of care cranial ultrasound for ICH diagnosis to inform imaging techniques, cranial topography on B mode and sample size estimation for future studies to evaluate sensitivity and specificity of cranial POCUS in adult patients. This pilot study is limited by small sample size and over representation of ICH in the study. Cranial POCUS is feasible using POCUS machines and may have potential as a screening tool if validated in adequately powered studies.

Dataset Information

Intracranial hemorrhage detected through a craniotomy site with point of care ultrasound.

Publications

Intracranial hemorrhage detected through a craniotomy site with point of care ultrasound.

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