{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:46:23Z","timestamp":1790077583422,"version":"4.0.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T00:00:00Z","timestamp":1700006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>An increase in cerebral blood flow is frequent after traumatic brain injury (TBI) and can lead to brain swelling and refractory intracranial hypertension. We hypothesized that Transcranial EcoDoppler (TCD) monitoring could be useful to detect the cause of intracranial hypertension in these patients. Our main objective was to investigate if the increase of velocity in the middle cerebral artery (MCA) on TCD could be associated with intracranial hypertension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively studied TBI patients consecutively monitored with TCD. Hyperemia was defined as MCA mean velocity higher than 80\u2009cm\/s. Intracranial hypertension was considered when hyperosmolar therapy, hyperventilation, or deep sedation was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found hyperemia in 40 patients out of 118 (33.9%). On average, it started at day 2.1\u2009\u00b1\u20090.9 from admission and significantly increased (MCA velocity at day 1: 74\u2009\u00b1\u200925\u2009cm\/s vs. 109\u2009\u00b1\u200936\u2009cm\/s at day 4; <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Intracranial hypertension was significantly associated with hyperemia, occurring in 92.5% of hyperemic and 51.3% of non-hyperemic patients (<jats:italic>p<\/jats:italic> &amp;lt;\u20090.001). Moreover, we found that hyperemia preceded severe intracranial hypertension (<jats:italic>p<\/jats:italic> &amp;lt;\u20090.0001). In a logistic regression model, hyperemia was the only variable significantly correlated with intracranial hypertension (OR 10.64; <jats:italic>p<\/jats:italic> &amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Hyperemia was frequent in our population of TBI patients and preceded intracranial hypertension. TCD monitoring, if performed on a daily regular basis, can be a useful method to detect this phenomenon and to guide the therapy. It could be a tool for a cause-oriented therapy of intracranial hypertension.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1259180","type":"journal-article","created":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T18:59:27Z","timestamp":1700074767000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?"],"prefix":"10.3389","volume":"14","author":[{"given":"Camilla","family":"Gelormini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Ioannoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Scavone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Pisapia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Signorelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Montano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Piastra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anselmo","family":"Caricato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1016\/S0140-6736(66)92199-4","article-title":"The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis localised within the brain","volume":"2","author":"Lassen","year":"1966","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3171\/jns.1997.87.1.0009","article-title":"Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm","volume":"87","author":"Martin","year":"1997","journal-title":"J Neurosurg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3171\/jns.1984.61.2.0241","article-title":"Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension","volume":"61","author":"Obrist","year":"1984","journal-title":"J Neurosurg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1001\/jamaneurol.2019.3854","article-title":"Spatial and temporal pattern of ischemia and abnormal vascular function following traumatic brain injury","volume":"77","author":"Launey","year":"2020","journal-title":"JAMA Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"762","DOI":"10.3171\/jns.1996.85.5.0762","article-title":"Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome","volume":"85","author":"Kelly","year":"1996","journal-title":"J Neurosurg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s11910-016-0672-3","article-title":"The utility of cerebral blood flow assessment in TBI","volume":"16","author":"Akbik","year":"2016","journal-title":"Curr Neurol Neurosci Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/978-3-7091-1434-6_50","article-title":"Application of transcranial color-coded sonography in severe brain injury","volume":"118","author":"Turek","year":"2013","journal-title":"Acta Neurochir Suppl"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40477-018-0282-9","article-title":"Transcranial Doppler ultrasound in neurocritical care","volume":"21","author":"Blanco","year":"2018","journal-title":"J Ultrasound"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/S1042-3680(18)30807-6","article-title":"Transcranial Doppler in cerebral vasospasm","volume":"1","author":"Newell","year":"1990","journal-title":"Neurosurg Clin N Am"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s40560-016-0138-3","article-title":"Traumatic brain injury: pathophysiology for neurocritical care","volume":"4","author":"Kinoshita","year":"2016","journal-title":"J Intensive Care"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.3171\/jns.1992.77.1.0015","article-title":"Blood pressure and intracranial pressure-volume dynamics in severe head injury: relationship with cerebral blood flow","volume":"77","author":"Bouma","year":"1992","journal-title":"J Neurosurg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1007\/BF01411999","article-title":"Quantitative cerebral blood flow and metabolism determination in the first 48 hours after severe head injury with a new dynamic SPECT device","volume":"139","author":"Della Corte","year":"1997","journal-title":"Acta Neurochir"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1136\/jnnp.55.7.594","article-title":"Cerebral blood flow, arteriovenous oxygen difference, and outcome in head injured patients","volume":"55","author":"Robertson","year":"1992","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e191152","DOI":"10.1001\/jamasurg.2019.1152","article-title":"Association of Statewide Implementation of the prehospital traumatic brain injury treatment guidelines with patient survival following traumatic brain injury: the excellence in prehospital injury care (EPIC) study","volume":"154","author":"Spaite","year":"2019","journal-title":"JAMA Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1007\/BF01476289","article-title":"Hyperaemia prior to acute cerebral swelling in severe head injuries: the role of transcranial Doppler monitoring","volume":"123","author":"Muttaqin","year":"1993","journal-title":"Acta Neurochir"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/0022-510X(95)00178-X","article-title":"Incidence and effects of increased cerebral blood flow velocity after severe head injury: a transcranial Doppler ultrasound study II. Effect of vasospasm and hyperemia on outcome","volume":"134","author":"Zurynski","year":"1995","journal-title":"J Neurol Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"E2","DOI":"10.3171\/2019.9.FOCUS19611","article-title":"Transcranial Doppler ultrasonography in neurological surgery and neurocritical care","volume":"47","author":"Bonow","year":"2019","journal-title":"Neurosurg Focus"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1089\/neu.2015.3967","article-title":"Use of transcranial Doppler in patients with severe traumatic brain injuries","volume":"34","author":"Ziegler","year":"2017","journal-title":"J Neurotrauma"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"E14","DOI":"10.3171\/2017.8.FOCUS17431","article-title":"Traumatic brain injury and intracranial hemorrhage\u2013induced cerebral vasospasm: a systematic review","volume":"43","author":"Al-Mufti","year":"2017","journal-title":"Neurosurg Focus"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"131","DOI":"10.3171\/jns.1973.38.2.0131","article-title":"Regional cerebral blood flow, intracranial pressure and brain metabolism in comatose patients","volume":"38","author":"Bruce","year":"1973","journal-title":"J Neurosurg"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1259180\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T18:59:31Z","timestamp":1700074771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1259180\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,15]]},"references-count":20,"alternative-id":["10.3389\/fneur.2023.1259180"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2023.1259180","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,15]]},"article-number":"1259180"}}