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Embolic stroke by compression maneuver during transcranial Doppler sonography
N Khaffaf1, R Karnik, W B Winkler
1Second Department of Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Stroke
|May 1, 1994
Summary
Ultrasound compression maneuvers can cause embolic stroke, even with small carotid plaques. Avoid these maneuvers in patients with recent neurological symptoms to prevent serious complications like stroke.
Area of Science:
- Neurology
- Vascular Ultrasound
- Neuroimaging
Background:
- Embolic complications during ultrasound examinations are infrequent but can lead to significant neurological deficits.
- Transcranial Doppler (TCD) and Duplex sonography are valuable tools for cerebrovascular assessment.
Observation:
- A 63-year-old male with transient ischemic attacks experienced a stroke during TCD.
- A nonobstructive plaque was noted at the right carotid bifurcation.
- A compression maneuver on the right common carotid artery led to detected emboli and neurological symptoms.
Findings:
- The patient developed left-sided hemiparesis and slurred speech, indicative of a minor stroke.
- Funduscopy confirmed cholesterol emboli in the right eye's arteriole.
- These findings strongly suggest embolization as the stroke's cause.
Implications:
- Compression maneuvers during carotid ultrasound are contraindicated in patients with recent neurological symptoms.
- Even small extracranial carotid lesions pose an embolic risk when manipulated.
- This case highlights the importance of careful technique and patient selection in cerebrovascular ultrasound.