Transcranial Doppler: Techniques and advanced applications: Part 2

Sharma, Arvind; Bathala, Lokesh; Batra, Amit; Mehndiratta, Man Mohan; Sharma, Vijay K

doi:10.4103/0972-2327.173407

Cited by 13 publications

(11 citation statements)

References 21 publications

(18 reference statements)

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“…[18] It was calculated for bilateral MCAs in all study participants, according to a validated standardised method at our neurovascular laboratory. [19] Briefly, the Probe Holder LMY-3 (Rimed Ltd, Israel) was used to fix the TCD monitoring probes for bilateral MCA. Subjects were asked to hold breath for 30 seconds and MFVs in the MCAs were monitored.…”

Section: Methodsmentioning

confidence: 99%

Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics

et al. 2019

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ObjectivesForest fires in South Asia lead to widespread haze, where many healthy individuals develop psychosomatic symptoms. We investigated the effects of haze exposure on cerebral hemodynamics and new symptoms. We hypothesised that vasoactive substances present in the haze, would lead to vasodilation of cerebral vasculature, thereby altering cerebral hemodynamics, which in turn may account for new psychosomatic symptoms.MethodsSeventy-four healthy volunteers were recruited, and serial transcranial Doppler (TCD) ultrasonography was performed to record blood flow parameters of bilateral middle cerebral arteries (MCA). The first TCD was performed in an air-conditioned environment. It was repeated outdoors after the participants spent 30-minutes in the haze environment. The prevailing level of pollutant standards index (PSI) was recorded. Appropriate statistical analyses were performed to compare cerebral hemodynamics at baseline and after haze exposure in all participants. Subgroup analyses were then employed to compare the findings between symptomatic and asymptomatic participants.ResultsStudy participants’ median age was 30 years (IQR 26–34), and new psychosomatic symptoms were reported by 35 (47.3%). There was a modest but significant decrease in pulsatility index (PI) and resistivity index (RI) in the left MCA after haze exposure (PI: p = 0.026; RI: p = 0.021). When compared to baseline parameters, haze exposure resulted in significantly lower mean PI (p = 0.001) and RI (p = 0.001) in symptomatic patients, but this difference was not present in asymptomatic patients (PI: p = 0.919; RI: p = 0.970).ConclusionHaze causes significant alterations in cerebral hemodynamics in susceptible individuals, probably responsible for various psychosomatic symptoms. The prognostic implications and health effects of haze require evaluation in a larger study.

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Section: Methodsmentioning

confidence: 99%

Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics

et al. 2019

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“…[ 171 ]. Advanced applications of TCD in neurovascular diseases have been extensively revised in [ 172 , 173 , 174 , 175 ].…”

Section: Trans-cranial Doppler (Tcd)mentioning

confidence: 99%

Brain Vascular Imaging Techniques

Laviña

2016

IJMS

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Recent major improvements in a number of imaging techniques now allow for the study of the brain in ways that could not be considered previously. Researchers today have well-developed tools to specifically examine the dynamic nature of the blood vessels in the brain during development and adulthood; as well as to observe the vascular responses in disease situations in vivo. This review offers a concise summary and brief historical reference of different imaging techniques and how these tools can be applied to study the brain vasculature and the blood-brain barrier integrity in both healthy and disease states. Moreover, it offers an overview on available transgenic animal models to study vascular biology and a description of useful online brain atlases.

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“…As per protocol, all enrolled patients underwent bilateral Middle Cerebral Artery (MCA) TCD emboli detection monitoring, as soon as possible for a duration of one hour. 3 Those with positive MES underwent second monitoring at 48 hours of the initial study. Treatments given during the interval period were carefully recorded.…”

Section: Methodsmentioning

confidence: 99%

“…1 It is technically feasible in most patients and it provides clinically useful information about future stroke risk for patients with carotid disease. 2 Micro-Embolic Signals (MES) detected by TCD emboli detection monitoring 3 is a marker of stroke and TIA in symptomatic carotid stenosis (SCS) as well as asymptomatic carotid stenosis (ACS) 4,5 and hence the strategies to abolish the MES are important. Dual antiplatelet therapy with aspirin and clopidogrel significantly reduces the MES compared with aspirin alone in symptomatic intracranial carotid and middle cerebral artery stenosis.…”

Section: Introductionmentioning

confidence: 99%

Abolition of micro embolic signals in symptomatic carotid stenosis using dual antiplatelet therapy

Khan¹,

Shehna²,

Ghafoor³

2020

IJN

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Micro-Embolic Signals (MES) detected by Trans-Cranial Doppler (TCD) in symptomatic carotid stenosis (CS) are considered a marker of subsequent stroke. We aimed to investigate the role of antiplatelet and antithrombotic agents in abolishing the MES in recently symptomatic CS. Materials and Methods: Transient ischemic attack/stroke patients with 50%CS or unstable carotid plaque, who were prospectively enrolled within 48hours of symptom onset, underwent bilateral middlecerebral artery one-hour TCD emboli monitoring within 48hours. Those with MES underwent second monitoring at 48hours of the initial study. Treatment given during the interval period was recorded. Results: Out of 73 patients enrolled from April 2016 to March 2019, 22 (17 males, mean age 67.4years) had ipsilateral MES on initial TCD (30.1%). Ten were on a single-antiplatelet agent (aspirin/clopidogrel) and one was on dual (aspirin&clopidogrel) therapy prior to this. Single-antiplatelet agent was started after TCD in seven, dual-agents in six and unfractionated-heparin in seven patients. Second TCD showed no MES in 14 patients. Only one out of three on a single antiplatelet agent alone had abolition of MES while all ten patients on dual-antiplatelet agents had a complete suppression (p=0.027,Chi-square test). Although heparin suppressed MES in 5/7 patients, all five had additional dual-agent therapy. MES was not abolished in one patient treated with heparin alone and another one on a combination of heparin and single-antiplatelet agent. Conclusion: Aspirin/Clopidogrel combination is very effective in suppressing arterial emboli in recently symptomatic carotid stenosis whereas unfractionated-heparin, single-antiplatelet agent or their combination is not useful for the same.

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Transcranial Doppler: Techniques and advanced applications: Part 2

Cited by 13 publications

References 21 publications

Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics

Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics

Brain Vascular Imaging Techniques

Abolition of micro embolic signals in symptomatic carotid stenosis using dual antiplatelet therapy

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