Temporal bone thickness and texture are major determinants of the high rate of insonation failures of transcranial doppler in amerindians (the Atahualpa Project)

Brutto, Oscar H. Del; Mera, Robertino M.; Andrade, María de la Luz; Espinosa, Verónica; Castillo, Pablo R.; Zambrano, Mauricio; Náder, Juan

doi:10.1002/jcu.22284

Cited by 15 publications

(12 citation statements)

References 16 publications

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“…Further studies are warranted for defining age-and sex-adjusted reference values of flow velocities and cIMT and clarifying its sensitivity and specificity for the diagnosis of atherosclerosis in sub-Saharan Africa. On the other hand, we report a high failure rate of TCCS, confirming findings from previous studies indicating that people of African descent, females and elderly subjects have higher rates of transcranial insonation failure due to greater thickness of the temporal bone [14]. This suggests that using echocontrast agents might be mandatory for the study of intracranial atherosclerosis in African settings when other imaging techniques are not affordable.…”

Section: Discussionsupporting

confidence: 89%

“…Although TCCS is validated for the diagnosis and monitoring of intracranial atherosclerosis, it can underestimate the overall burden of intracranial atherosclerosis. Indeed, its sensitivity is decreased in case of poor-quality insonation windows [14] and in mild stenoses without hemodynamic repercussions. Moreover, the examination of the extracranial vertebral artery is technically challenging, the portions outside the vertebral canal are often difficult to identify with confidence and not always accessible.…”

Section: Discussionmentioning

confidence: 99%

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A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome

et al. 2020

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Background In sub-Saharan Africa, there is a dearth of epidemiologic data on the burden of cerebral atherosclerosis. This is explained by the limited availability and the high cost of standard vascular imaging techniques. Neurovascular ultrasound is portable, cheaper and non-invasive and could, therefore, represent a reasonable alternative to fill this knowledge gap. We explored the feasibility of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome to inform the design of future large stroke studies comparing its diagnostic performance to that of gold standard vascular imaging techniques in sub-Saharan Africa. Methods We enrolled consecutive patients diagnosed with acute stroke-like syndrome based on the World Health Organization definition. Clinical and demographic data were recorded, and a comprehensive neurovascular ultrasound was performed. Fisher's exact and Kruskal-Wallis tests were used to study the relationship between atherosclerosis and potential risk factors. Results Sixty-six patients were enrolled (mean age: 58.7 years). The frequency of extracranial atherosclerosis was 39.4% (n = 26, 95% CI: 28.6-52.2). There were 12 patients with abnormal carotid intima media thickness (18.2%, 95% CI: 9.8-29.6) and 14 patients with a carotid plaque (21.2%, 95% CI: 12.1-33.0). The frequency of intracranial atherosclerosis was 19.2% (95%CI: 6.6-39.4) in 26 patients with successful transcranial insonation. Hypertension

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome

et al. 2020

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“…Thirteen of the 38 persons had absent transtemporal windows precluding insonation of both MCAs and therefore were excluded. (These high rates of absent windows were related to increased thickness and heterogeneity of temporal squama in our population of Amerindians [ 14 , 15 ].…”

Section: Resultsmentioning

confidence: 99%

The association of sleep-disordered breathing with high cerebral pulsatility might not be related to diffuse small vessel disease. A pilot study

et al. 2015

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Background In a population-based sampling study conducted in community-dwelling older adults living in rural Ecuador, we aimed to assess the relation among sleep-disordered breathing, cerebral pulsatility index, and diffuse small vessel disease. MethodsOf 25 participants, 9 (36 %) had moderate-to-severe sleep-disordered breathing, characterized by an apnea/hypopnea index ≥15 per hour, and 10 (40 %) had moderate-to-severe white matter hyperintensities, graded according to the modified Fazekas scale. Mean (SD) pulsatility index in the middle cerebral artery was 1.18 (0.19) and positively correlated with the apnea/hypopnea index (R = .445, P = .03, [Pearson’s correlation coefficient]). The middle cerebral artery pulsatility index was increased in persons with moderate-to-severe sleep-disordered breathing compared with persons who had none-to-mild sleep-disordered breathing (mean [SD] 1.11 [0.12] vs. 1.3 [0.23], P = .01). No significant differences were found in the prevalence of moderate-to-severe white matter hyperintensities across groups of sleep-disordered breathing (P = .40) or in the mean apnea/hypopnea index across groups of persons with none-to-mild or moderate-to-severe white matter hyperintensities (P = .16). ConclusionsThis pilot study shows that moderate-to-severe sleep-disordered breathing correlates with cerebral pulsatility, but such association might be independent of diffuse small vessel disease.

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“…Increased thickness of temporal bones and the presence of exuberant cancellous bone (diploe) account for the high rate of TCD failures among women, older individuals and people of different ethnic groups. 3,4 In addition, air may also interfere with proper assessment of signal flows from intracranial arteries. Aberrant pneumatization of temporal squamas were recognized as responsible for TCD failures in only one study, 5 but no further attention has been given to this condition, which is thought to be more common in persons with recurrent ear infections, nasal deflections or in those exposed to frequent high altitude travel or Valsalva maneuvers.…”

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confidence: 99%

Temporal Squama Pneumatization: An Under-Recognized Limitation Of Transcranial Doppler

Brutto¹,

Náder²

2021

revecuatneurol

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Temporal bone thickness and texture are major determinants of the high rate of insonation failures of transcranial doppler in amerindians (the Atahualpa Project)

Abstract: Temporal bone thickness and texture are independent predictors of TCD insonation failure in Amerindians.

Cited by 15 publications

References 16 publications

A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome

A cross-sectional feasibility study of neurovascular ultrasound in Malawian adults with acute stroke-like syndrome

The association of sleep-disordered breathing with high cerebral pulsatility might not be related to diffuse small vessel disease. A pilot study

Temporal Squama Pneumatization: An Under-Recognized Limitation Of Transcranial Doppler

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