Narrative Review: Critical Care Neurosonology Symposium for the 50th Year Celebration of Wake Forest Ultrasound

ABSTRACT Introduction Neurosonology has emerged as an important bedside tool in neurocritical care, offering real‐time insights into cerebral hemodynamics and intracranial physiology. This narrative review summarizes expert presentations and selected literature discussed during the Critical Care Neurosonology Symposium held in May 2025 in celebration of the 50th anniversary of Wake Forest Ultrasound. Methods This symposium‐based narrative review synthesizes expert presentations and selected literature on the clinical applications of neurosonology in critical care. Topics included transcranial Doppler (TCD), B‐mode cerebral ultrasound, and ocular ultrasound across neurological and systemic critical illnesses. Results TCD can provide non‐invasive assessment of cerebral hemodynamics, estimation of intracranial pressure (ICP), and evaluation of cerebral autoregulation. While it does not replace invasive monitoring, it may support individualized cerebral perfusion assessment in selected patients. TCD is also used as an ancillary test in the diagnosis of cerebral circulatory arrest, though standardized protocols remain limited. In subarachnoid hemorrhage, serial TCD monitoring is widely applied to detect vasospasm and assess risk for delayed cerebral ischemia. In systemic critical illness, neurosonology may help characterize cerebral perfusion abnormalities in sepsis, hepatic encephalopathy, cardiac arrest, and patients receiving mechanical circulatory support. Complementary modalities including ocular ultrasound and B‐mode imaging can provide indirect markers of ICP elevation, cerebral edema, and midline shift. Conclusion Neurosonology provides a dynamic, non‐invasive window into the critically ill brain. However, important gaps remain in standardization, operator training, and outcome‐driven validation. Future research should focus on protocol harmonization and multicenter trials to better define the role of neurosonology in guiding neurocritical care management.