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Transcranial Doppler in acute hemispheric brain infarction
M J Kushner1, E M Zanette, S Bastianello
1Department of Neurology, University of Pennsylvania, Philadelphia.
Insights
Transcranial Doppler (TCD) ultrasonography effectively identifies middle cerebral artery (MCA) occlusions in acute ischemic stroke. Early TCD findings predict the extent of brain damage and long-term prognosis.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Acute ischemic stroke requires rapid assessment of cerebrovascular anatomy and blood flow.
- Middle cerebral artery (MCA) occlusions are a common cause of severe hemispheric infarction.
- Early detection of MCA status is crucial for timely intervention and prognosis.
Purpose of the Study:
- To evaluate the utility of transcranial Doppler (TCD) ultrasonography in assessing MCA status in acute ischemic stroke.
- To correlate TCD findings with intra-arterial digital angiography and clinical outcomes.
- To determine if early TCD can predict long-term brain damage.
Main Methods:
- 42 patients with acute hemispheric ischemic brain infarction were studied.
- Intra-arterial digital angiography and TCD ultrasonography were performed within 6 hours of symptom onset.
- Computed tomography (CT) assessed chronic ischemic brain damage 1-3 months post-stroke.
Main Results:
- Abnormal TCD findings (absent signal or low velocity) strongly correlated with proximal MCA occlusions on angiography.
- Abnormal TCD predicted larger chronic CT lesions and more extensive ischemic changes.
- Early TCD provided valuable prognostic information regarding cerebral tissue.
Conclusions:
- Early TCD is a valuable, non-invasive tool for detecting MCA occlusions in acute ischemic stroke.
- TCD findings in the early phase of stroke correlate with the severity and extent of brain infarction.
- Abnormal TCD signals early in stroke can predict long-term neurological damage and prognosis.
Abstract:
We studied cerebrovascular anatomy using intra-arterial digital angiography, and blood flow velocity in the middle cerebral artery (MCA) using transcranial Doppler (TCD) ultrasonography in 42 patients with acute hemispheric ischemic brain infarction. We compared angiography with TCD and the clinical findings within 6 hours of the onset of symptoms. The location and extent of the chronic ischemic brain damage was assessed by CT performed 1 to 3 months after the ictus. Abnormal TCD, as manifested by either an unobtainable MCA flow signal or a significantly depressed MCA flow velocity, was highly associated with proximal MCA occlusions demonstrated by angiography. Abnormal TCD predicted both larger chronic CT lesions and more extensive ischemic change within the MCA territory. These data demonstrate that early TCD conveys useful information concerning cerebral tissue prognosis following hemispheric ischemia.