ultrasound has been widely used for rapid assessment of critical illness and is regarded as a visual stethoscope .
there are few reports on the diagnosis of intracranial lesions by ultrasound in icu patients . here
we present a multiple trauma patient who had undergone craniectomy and in whom recurrent intraventricular hemorrhage was rapidly detected by ultrasound .
a 29-year - old man was transferred from a local hospital 9 hours after a 5-meter fall .
his glascow coma score ( gcs ) was 4 and both pupils were unequal in size .
the diagnosis was severe cerebral contusion and subdural hemotoma in the left temporal and parietal lobe , bilateral lung contusion and left clavicle fracture .
he received an urgent decompressive craniectomy and evacuation of hematoma , and was then admitted to the emergency icu . in the following days ,
his condition improved and his gcs reached 8 , although this suddenly decreased to 6 on day 12 .
bedside ultrasound was performed instantly and showed acute intraventricular hemorrhage ( ivh ) , which was confirmed by subsequent computed tomography ( ct ) ( figure 1 ) .
bedside ultrasound and a head ct scan were arranged immediately , both showing recurrence of ivh ( figure 1 ) .
the family refused further treatment and he then became brain dead ( figure 1 ) .
computed tomography and ultrasound images of the head in a multiple trauma patient with craniectomy and recurrent intraventricular hemorrhage .
( a , b ) head computed tomography ( ct ) before craniectomy showing severe cerebral contusion and the deformed left lateral ventricle .
( c , d ) head ct on the fi rst day post - craniectomy showing the absence of the skull and the normal left lateral ventricle .
( e ) ultrasound image corresponding to the ct scan shown in ( d ) ; ( f ) the normal doppler pattern of the left middle cerebral artery ( lmca ) .
( g - i ) head ct and ultrasound images after the fi rst intraventricular hemorrhage ( ivh ) : ( g , h ) hematocele in both lateral ventricles ; ( i ) slightly abnormal doppler pattern of the lmca .
( j - l ) head ct and ultrasound images after the second ivh : ( j , k ) both enlarged lateral ventricles with hematocele compared with ( g ) ; ( l ) reverse blood fl ow during the diastolic period of lmca .
the absence of the skull may facilitate the ultrasound to detect the brain , and intracranial morphological abnormal signs such as dislocation of the midline , intracerebral hematomas , size of lateral ventricular and hydrocephalus may be clearly displayed on the screen .
this rapid and non - invasive method can complement the results of ct and may help to reduce delays in surgical management .
caricato and colleagues   found that ultrasound in patients with decompressive craniectomy was as effective as ct to evaluate intracerebral disorders . in this multiple trauma patient , ivh happened twice after the craniectomy and was immediately identified by ultrasound .
meanwhile , ultrasound may detect the characteristics of cerebral blood flow , which helps to assess intracranial pressure and cerebral perfusion pressure .
ct : computed tomography ; gcs : glascow coma score ; ivh : intraventricular hemorrhage .
 ultrasound may be a useful tool to evaluate intracranial abnormalities in critically ill patients undergoing decompressive craniectomy . 
 we present a multiple trauma patient who had undergone craniectomy and in whom recurrent intraventricular hemorrhage and patterns of cerebral blood flow were rapidly detected by ultrasound . 
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