Bedside transcranial Doppler as a diagnostic bridge for suspected intracranial hypertension after traumatic brain injury surgery: A case report

Background: Early recognition of postoperative neurologic deterioration in patients with traumatic brain injury (TBI) is essential but remains challenging, as clinical assessment may lack sensitivity and computed tomography (CT) imaging is not always immediately available. Transcranial Doppler (TCD) provides a noninvasive bedside method to detect early hemodynamic abnormalities, including impaired perfusion and increased vascular resistance. This case report highlights the role of TCD in recognizing early indicators of intracranial hypertension and prompting expedited CT evaluation. Case Description: A 20-year-old male presented with an acute decline in consciousness following a traffic accident. Initial CT imaging revealed an epidural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, cerebral edema, and a temporoparietal depressed skull fracture. The patient underwent decompressive craniectomy with hematoma evacuation. On postoperative day 1, neurologic status failed to improve, accompanied by anemia and elevated lactate. Bedside TCD demonstrated an increased pulsatility index (PI 1.49) and hypoechoic–hyperechoic changes in the lateral ventricle suggestive of new hemorrhage or cerebrospinal fluid accumulation. These findings prompted an urgent repeat CT scan, which confirmed new intracranial bleeding and the need for reoperation. Following re-craniotomy and further stabilization, repeat TCD showed a reduced PI (1.09) consistent with improved hemodynamics. Conclusion: When clinical assessment is limited and CT imaging is delayed, TCD serves as a valuable bedside tool for early recognition of rising intracranial pressure or new hemorrhage. Although not a substitute for CT, TCD functions as a diagnostic bridge that accelerates clinical decision-making in critical postoperative TBI care.