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Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
Transcranial color doppler study for reversible cerebral vasoconstriction syndromes
Shih-Pin Chen1, Jong-Ling Fuh, Feng-Chi Chang
1Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Annals of Neurology
|May 23, 2008
Summary
Reversible cerebral vasoconstriction syndromes (RCVS) involve prolonged vasoconstriction, increasing risks of stroke and leukoencephalopathy even after headaches resolve. Specific vasospasm criteria indicate a higher risk for these complications.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Reversible cerebral vasoconstriction syndromes (RCVS) are defined by thunderclap headaches and temporary cerebral artery narrowing.
- Systematic studies on cerebral hemodynamics in RCVS are lacking.
Purpose of the Study:
- To investigate cerebral hemodynamics in patients with RCVS using transcranial Doppler ultrasonography.
- To compare hemodynamic parameters between RCVS patients and controls.
Main Methods:
- Consecutive recruitment of patients diagnosed with RCVS.
- Serial transcranial color-coded sonography of the middle cerebral artery (MCA) over three months.
- Measurement of mean flow velocities (V(MCA)) and Lindegaard Index (LI), compared to healthy controls.
Main Results:
- Thirty-two female patients (mean age 49.7 years) were studied.
- RCVS patients exhibited significantly higher V(MCA) (109.5 cm/sec) and LI (2.2) than controls (66.3 cm/sec and 1.4, respectively; p < 0.001).
- Elevated V(MCA) and LI persisted even at headache resolution (mean day 22). Patients meeting subarachnoid hemorrhage mild vasospasm criteria (V(MCA) > 120 cm/sec, LI > 3) had increased risks of posterior leukoencephalopathy (75% vs 4%) and ischemic stroke (50% vs 0%).
Conclusions:
- RCVS is associated with prolonged cerebral vasoconstriction, extending risks beyond headache resolution.
- The presence of mild vasospasm criteria in RCVS patients signifies a heightened risk for severe neurological complications like posterior leukoencephalopathy and ischemic stroke.
