Brachiocephalic Vessels Ultrasound Index of Arteriovenous Ratio (IAVR) and Headache as a Diagnostic Tool for Intracranial Venous Stasis in Arterial/Venous Ischemic Stroke’s Differentiation

Abstract

Identification of signs of intracranial venous stasis using ultrasound methods in combination with determination of headache intensity according to the visual-analogue scale allows us to suspect the venous genesis of ischemic stroke before using neuroimaging methods, which can contribute to the selection of adequate therapy and to improve the prognosis and long-term outcomes of the disease. Objective: To study the prognostic value of a complex of clinical demographic and instrumental indicators for developing a model for early differential diagnosis of ischemic stroke of arterial and venous origin. Material and Methods: Examined 124 patients with ischemic stroke: 22 with venous stroke due cerebral venous sinus thrombosis (VIS), 53.5±16.7y and 102 with atherothrombotic stroke (AIS), 68.3±12.1y which were verified by native CT; CT-angiography, PCT (perfusion CT: CBF, CBV, MTT), brachiocephalic vessels ultrasound index of arteriovenous ratio (IAVR) and transcranial duplex scanning for all. IAVR was obtained due duplex scanning of carotid common arteries (CCA) and internal jugular veins (IJV) according to the formula: V max IJV optimal =2S CCA × Vps CCA/ 3S IJV……… (1) IAVR = max IJV actual / V max IJV optimal × 100%, where……… (2) IAVR-index of arteriovenous ratio, (%) Vps CCA-peak systolic velocity of the CCA, cm/s Vmax IJV-maximum blood flow velocity, cm/s. S-vessel cross-sectional area, cm 2 , as well as. To assess the neurological status of patients, rating scales were used, including a visually analog headache intensity scale. Results: The greatest prognostic significance was possessed by such parameters as the indicator of arteriovenous blood flow ratio and the value of headache intensity on a visual-analogue scale. A model for the differential diagnosis of AIS and VIS, which has high specificity and sensitivity, has been developed. Velocity indicators in the veins of Rosenthal and the vein of Galen are additional signs of intracranial venous stasis.