Transcranial Doppler (TCD) is commonly used in the monitoring of neuro-critical patient. In the subarachnoid hemorrhage is used in the early diagnosis of cerebral vasospasm. We studied a 30 years old male patient, with severe traumatic brain injury, and right epidural parietal hematoma, right cerebellum hematoma and posttraumatic subarachnoid hemorrhage in posterior territory. The initial Glasgow Coma Score (GCS) was in 4 points. TCD was done one day 2, 3, 6, 14 y 21. We used as vasospasm diagnosis in basilar artery, the criteria of VmBA >95 cm/sec and VmBA /VmECVA > 2 referred to Soustiel Ratio (SI). The patient was diagnosed with early vasospasm of the basilar artery on day 3, based on a VmBA = 121 cm/ sec and SI = 3.36. The patient was treated with nimodipine immediately of vasospasm diagnosis. It also had neurosurgical treatment with evacuation of the epidural and cerebellum hematoma. Repeat TCD measurement was not done until day 6, the VmBA was 79 cm/sec and the IS was 2.29. It was transferred to another floor after 25 days in the ICU, with a GCS of 12. The TCD was used as a diagnosis kit in the vasospasm and show his usefulness in the develop tracing of traumatic subarachnoid hemorrhage in posterior territory. It showed the TCD value in the monitoring of neurocritical patient with severe brain injury and high suspicion of vasospasm develop.

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