Assessment: Transcranial Doppler ultrasonography: [RETIRED]

Sloan, Michael A.; Alexandrov, Andrei V.; Tegeler, Charles H.; Spencer, M. P.; Caplan, Louis R.; Feldmann, E.; Wechsler, L. R.; Newell, David W.; Gomez, C. R.; Babikian, V. L.; Lefkowitz, D.; Goldman, R. S.; Armon, C.; Hsu, Chung Y.; Goodin, D. S.

doi:10.1212/wnl.62.9.1468

Cited by 498 publications

(145 citation statements)

References 159 publications

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“…Because elderly patients are difficult for TCD, there seemed to be selection bias of patients in this study. However, as a method which could quantify right‐to‐left shunt (RLS) directly, c‐TCD has a class IIa recommendation for RLS detection as well as TEE,41 and have been recommended as the first choice for screening PFO 22. When compared with TEE,42 it has been demonstrated that contrast‐TCD is more feasible in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical and infarction patterns of PFO‐related cryptogenic strokes and a prediction model

Shi

et al. 2018

Ann Clin Transl Neurol

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ObjectivesThe higher than expected PFO rate in CS patients has raised concerns that paradoxical embolism maybe the pathophysiologic mechanism for strokes. However, only a small proportion of pathogenic PFOs cause CS. Therefore, accurate recognition of patients with pathogenic PFOs among all CS patients could guide clinical decision making in selecting the most appropriate treatment. The aim of this study was to devise a new algorithm to stratify cryptogenic stroke (CS) patients into pathogenic patent foramen ovale (p‐PFO)‐ and non‐p‐PFO‐related patients.MethodsA total of 1201 patients with acute ischemic stroke were recruited from two different medical centers, and 253 CS patients were identified. Of the 253 patients, 111 were diagnosed with PFO using contrast transcranial Doppler. Data on medical histories, neuroimaging and laboratory tests were compared in CS patients with or without PFO.ResultsCompared with PFO‐negative CS patients, PFO‐positive CS patients showed younger onset age, lower incidence of hypertension and dyslipidemia, characteristic infarction pattern in magnetic resonance imaging and specifically altered platelet activity and coagulation function. Based on the above information, we constructed a PFO judgment formula (Hr‐PFOJ) by means of feature weight estimation and predictive performance evaluation to predict pathogenic PFO in CS patients with a sensitivity of 76.3% and a specificity of 66.5%.InterpretationsHr‐PFOJ judgment formula is a useful screening tool for identification of patients with pathogenic PFO who may benefit from PFO‐related treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical and infarction patterns of PFO‐related cryptogenic strokes and a prediction model

Shi

et al. 2018

Ann Clin Transl Neurol

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“…Thus, TCD has been proposed as a safe technique with no reports of technique-related complications and to assess brain perfusion noninvasively. The device is of potential benefit for intermittent or continuous monitoring of brain perfusion in the situations where the direct measurement is not available or its reliability is in question (20,22,24,25). Independent of the type of intracranial pathology, a strong correlation between PI and ICP is demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive estimation of cerebral perfusion pressure with transcranial Doppler ultrasonography in traumatic brain injury

Güra

Sılav²,

Isik³

et al. 2011

Turkish Neurosurgery

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AIM:In traumatic brain injury (TBI) patients, to overcome the secondary insults, cerebral perfusion pressure (CPP) oriented therapy is recommended. The study is assigned to estimate CPP values with middle cerebral artery (MCA) flow velocities measured noninvasively using transcranial Doppler ultrasonography (TCD). MATeRIAL and MeTHods:Forty-seven TBI patients were studied. Intracranial pressure (ICP), mean arterial pressure (MAP) and MCA flow velocities of the patients were monitored. Invasive CPP was calculated as the difference between MAP and ICP. The formula : 'MAP x FVd/FVm +14' was used to estimate CPP noninvasively. Correlation of the noninvasive and invasive values were analysed. ResULTs:The mean values of noninvasive CPP and invasive CPP were 66.10 ± 10.55 mmHg and 65.40 ± 10.03 mmHg respectively. The correlation between noninvasive and invasive CPP measurements was strongly significant (p < 0.001) with a correlation coefficient of r = 0.920. CoNCLUsIoN:With ICP monitoring systems, CPP is calculated and the therapy is guided according to these values. As it is recognized that brain perfusion can be assessed with TCD waveforms, noninvasive CPP estimation with MCA flow velocities may help to observe the trends in CPP values.

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“…Many centers, including our department, rely on cerebral angiography for the diagnosis of vasospasm. However, the American Academy of Neurology Expert Committee believes the use of TCD on the basis of the fact that although sensitivity and specificity are quite variable and depend on the vessel of interest, severe spasm can be identified with fairly high reliability [56].Recently perfusion computed tomography, diffusion weighted magnetic resonance imaging, and single photon emission computed tomography (SPECT) in detecting vasospasm is under investigation [57]. However, the effect of microsurgical treatment on incidence of vasospasm is not exactly known.…”

Section: Cerebral Vasospasmmentioning

confidence: 99%