Point of care B mode ultrasound in Neurological Emergencies

Bedside ultrasound allows diagnostic, therapeutic and monitoring approaches in critically ill patients. Currently ultrasound enables to perform a scan almost of all body regions in both adult and pediatric populations. Head and especially central nervous system, have traditionally been excluded, based on the idea that access to the brain is not possible given the limitation of the skull, Therefore in adults, the main ultrasound applications in central nervous system assessment have been limited to the transcranial Doppler and the measurement of the optic nerve sheath as a subrogate finding of intracranial hypertension. Nonetheless, through the temporal bone window it is possible to visualize the midline (third ventricle), nuclei basal ganglia, the mesencephalon and the lateral ventricles: the basic structures for the brain ultrasound Although the Gold standard for the initial assessment of many neurological pathologies in the emergency department is computed tomography; the ultrasonography allows an approximation to the midline shift and acute bleeding, combined with transcranial doppler some hemodynamics estimations can be acceded, this allow the diagnosis or follow-up of increased intracranial pressure which could favor pharmacological treatments and follow the therapeutic effect. In this review, basic B mode neurosonology for the emergency physician is explored and future directions discussed.