Imaging Techniques and in Management of Severe Head Injury in the ICU, Transcranial Scanning and its Clinical Relevance in a Poor Setting

Traumatic brain injury (TBL) is one of the leading causes of mortality and disability in Nigeria especially with the poor resources and worldwide as a whole. Due to the cost of computer tomography, transcranial sonography will be helpful in managing patient in a poor setting. This study reviews the role of transcranial sonography (TCS) in the management of patients with TBL. This study will also share our own experience in management of traumatic brain injured cases. The use of TCS is good and informative especially in low resource countries as it diagnoses patients with TBL, assessing midline shift, detects intracranial hematomas. The TCS is readily available for usage, is non-invasive, cheap compared to computed tomography (CT). TCS is very helpful in monitoring patients progress as it offers rapid neurovascular monitoring of patients who cannot be moved easily to the CT, thereby providing effective alternative initial diagnosis and monitoring. TCS is limited by its being operator dependent and little window for viewing the brain tissues in few cases. Despite this limitation, there is a high level of correlation between TCS and CT in detecting midline shift and other findings but confirmation is still needed using CT which is the gold standard. Our clinical case demonstrates that TCS is a fast and simple method for determining midline shift in a patient with TBL.