Abstract Details

Title Noninvasive Monitoring of Intracranial Pressure in Patients with Acute Liver Failure Using Transcranial Doppler Ultrasonography: A Pilot Study

Topic Neuro Trauma and Critical Care

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 7-008

Objective

To describe cerebral hemodynamics using transcranial Doppler (TCD) spectral waveform analysis in patients with acute liver failure (ALF) and encephalopathy, and to assess its potential for guiding management of intracranial pressure (ICP) through goal-directed hypertonic or hyperosmolar therapy.

Background Acute liver failure (ALF) causes cerebral edema and increased intracranial pressure (ICP), requiring early detection and management. Standard imaging and EEG do not accurately correlate with ICP. This pilot study explores transcranial Doppler (TCD) ultrasound to assess cerebral hemodynamics in ALF, with the goal of guiding hypertonic/hyperosmolar therapy.

Design/Methods Five ALF patients admitted to the ICU at North Shore University Hospital, were monitored using TCD on the day of admission, the day prior to orthotopic liver transplant (OLT), and postoperatively to assess cerebral blood flow velocities and infer ICP changes. Waveform features of the right middle cerebral artery (MCA), obtained via temporal windows, including mean flow velocity (MFV), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV), were analyzed. Symmetrical TCD data were also collected. The following flow patterns were defined: low-flow pattern when MFV was below normal reference values, independent of PI; high-resistance pattern with normal MFV and elevated PI; and hyperemia pattern when MFV was elevated, independent of PI.

Results Two patients with severe encephalopathy showed decreased MCA flow and high resistance before OLT, which resolved after transplant. One mild encephalopathy patient showed low flow and high resistance, and another displayed hyperemia; both improved post-OLT. Two toxic ALF patients with mild encephalopathy improved without OLT, with TCD showing normalized flow patterns alongside clinical recovery.

Conclusions TCD is a promising powerful non-invasive tool for ICP assessment in ALF patients. Common patterns observed were low flow with high resistance. Ongoing data collection may help refine its role in monitoring neurological complications, and providing insights into prognosis and the timing of OLT.

Authors/Disclosures
Eveline Gutzwiller, MD (Work) PRESENTER	Dr. Gutzwiller has nothing to disclose.
Rafia P. Jawed, MD (N/a)	Dr. Jawed has nothing to disclose.
Leonidha Duka (Northwell Health)	No disclosure on file
Céline De Matteo (Northwell Health)	No disclosure on file
Richard E. Temes, MD (Northwell Health)	No disclosure on file
Stacey Blake (Northwell Health)	No disclosure on file
Jennifer Onwochei, MD	Dr. Onwochei has nothing to disclose.

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