How Transcranial Doppler can assess the effect of hyperosmolar therapy and the degree of circulatory compromise in acute brain herniation

Patients in acute neurological extremes secondary to refractory intracranial hypertension are challenging because of the complex management options available to them, especially when compounded with signs of brainstem compromise. Objective evidence of cerebral circulatory compromise is often lacking. We present a case in which an objective evaluation of a cerebral circulatory compromise was documented using transcranial Doppler as well as its resolution with hyperosmolar therapy.