Visualizing Impending Cerebral Circulatory Arrest Caused by Intracranial Hypertension Following Aneurysmal Subarachnoid Hemorrhage

Intracranial hypertension may represent an important complication during the early phase following aneurysmal subarachnoid hemorrhage. 1 Timely diagnosis of intracranial hypertension is essential to avoid secondary brain ischemia; however, intracranial pressure (ICP) monitoring requires the insertion of catheters either within the brain ventricles or parenchyma, and hence, invasive ICP monitoring is not frequently utilized.2 Transcranial Doppler can be used for noninvasive ICP estimation through calculation of the pulsatility index (PI).3 We describe a case where noninvasive ICP monitoring with transcranial colorcoded Doppler (TCCD) rapidly identified a condition of severe intracranial hypertension, which led to a life-saving treatment.