Brain Ultrasonography

In patients with major trauma the use of ultrasound finds a pivotal role both in emergency room and in intensive care unit (ICU) as a point of care tool able to complete clinical examination. Classically, Focused Assessment Sonography for Trauma (FAST) aims the assessment of major lesions of chest and abdomen following the ABCDE as proposed by the Acute Trauma Life Support (ATLS) guidelines but leaving point “D” (Disability) unattended especially in situation where the patient is unconscious but hemodynamic instability hampers total body CT scan performance. Brain ultrasound (BUS) allows assessment of cerebral blood flow, midline displacement and estimation of cerebral perfusion pressure and intracranial pressure, providing thus precious information in such setting. Although BUS is not able to replace radiological imaging or invasive neurological monitoring, it still finds its place in ICU in the follow up of patients with either TBI and other acute neurological injuries especially in situation where invasive monitoring is not available or not fully indicated, in the monitoring of cerebral vasospasm and assessment of cerebral autoregulation.