[Transcranial Doppler sonography in neurotraumatology: hemodynamic monitoring of diffuse axonal injury].

: Six patients with diffuse axonal injury, ranging in age 8 to 29 years, hospitalized in emergency in our Polyclinic with a Glagow coma score under 8, were examined. Patients were intubated and connected to an automatic respirator. They underwent serial cranial CT and transcranial Doppler sonography recordings using the temporal window with insonation of the two middle cerebral arteries. During the period of observation, the metabolic processes and systemic hemodynamics were maintained within the limits of homeostasis. In all cases and at different times, osmotic diuretics (18% mannitol), barbiturates and hyperventilation therapy were administered. In 5 patients over 6 (80%) increased blood flow, variously sensitive to barbiturates, was detected associated to increased resistance index secondary to intracranial hypertension. Based on Doppler findings four patients underwent surgical treatment: ventriculostomy for monitoring of intracranial pressure or decompressive craniectomy. According to this experience, the use of transcranial Doppler US is mandatory for a correct identification of the hemodynamic injury associated to diffuse axonal injury, for planning the medical and/or surgical approach and for assessment of the successful results of therapeutic management.