Transcranial color-coded duplex sonography of intracerebral hematomas in adults.

Abstract

It is well established from pediatric experience and animal experiments that intracerebral blood can be demonstrated by B-mode real-time duplex scanning. This has recently become feasible in adults as well. The present study investigated the changes in the sonographic appearance of intracerebral hematomas over the course of time. Starting in May 1991, 23 consecutive patients with intracerebral hematoma confirmed by computed tomography (21 spontaneous and 2 traumatic hematomas) were investigated within 1 year. They were monitored by repeated ultrasound scanning via the transtemporal approach. The sonographic appearance of the hematomas on B-mode scans and the angle-corrected blood flow velocity in the basal cerebral arteries were assessed. There was unequivocal localization of the hematoma in 18 patients (78%). In 3 cases (13%), an adequate acoustic window could not be found. One small intracerebral hemorrhage was overlooked, and one extensive hemorrhage in the basal ganglia was misdiagnosed as a lobar hematoma. There was an alteration of the appearance of the hematoma with time. This was divided into three sonographic stages (initial stage, days 1 to 5; intermediate stage, days 6 to 10; and capsular stage, from day 10). In 14 of the 20 patients with an appropriate acoustic bony echo window, the blood flow velocity in the middle cerebral artery could be measured; in 1 of these patients, the signs of increasing intracranial pressure were apparent from Doppler frequency spectrum. In 5 patients, the intracerebral hematoma could be imaged but not the ipsilateral middle cerebral artery. One female patient showed cerebral circulatory arrest at the time of examination, which took place within 24 hours after the onset of clinical symptoms. Most intracerebral hematomas in adults can be imaged in B-mode. Their sonographic appearance changes over the course of the disease. The advantages of this noninvasive method are its easy bedside operation and its suitability for follow-up; it is also less stressful than other imaging procedures. It yields a combination of structural and functional diagnostic information. In approximately 13% of the cases, the investigation was not feasible because of inadequate ultrasonic penetration of the intact skull.

Transcranial Duplex Sonography for Monitoring Hyperacute Intracerebral Hemorrhage

“…To estimate ICH volume, we used the same formula previously described longitudinalϫsagittalϫcoronal/2. 11 Early hematoma growth with both CT and TDS was defined as an increase of Ͼ20% in ICH volume at 6 hours.…”

“…Although CT 9 and MRI 10 have shown high accuracy in hyperacute ICH diagnosis, TDS has some potential advantages, including the concomitant assessment of brain hemodynamics and the feasibility to be performed at the patient's bedside. 11,12 The aim of this study was to correlate ICH volume and ICH enlargement measured by TDS and CT scan in patients with supratentorial ICH evaluated within the first 3 hours after symptom onset.…”

Assessment: Transcranial Doppler ultrasonography: [RETIRED]

“…Parenchymal hematomas larger than 1 mL in size may be detected by TCCS, although smaller or cortical lesions may be missed. 149 Acute (Ͻ5 days old) hematomas may appear as echodense lesions when compared with surrounding tissues; evolutionary changes in ICH characteristics can be documented on serial scans. Complications of ICH such as intraventricular extension, hydrocephalus, and increased ICP can also be demonstrated.…”

“…Limited data suggest that for ICH, TCCS has excellent sensitivity, specificity, positive predictive value, and negative predictive value in patients with adequate transtemporal windows. 149 (Contrast-enhanced) TCCS is probably useful in the evaluation and monitoring of patients with aneurysmal SAH or intracranial ICA/MCA VSP following SAH (Type B, Class II to III evidence). Data are presently insufficient regarding the use of TCCS to replace CT for diagnosis of ICH (Type U).…”

Dynamic and three-dimensional transcranial sonography studies of an asymptomatic, cerebral convexity arachnoid cyst

“…[3,4,11,13,15,20] Since the early 1980s obtaining TCS images through the open anterior fontanelle has been the primary diagnostic procedure for pediatric patients, yielding excellent results. [1,5,10,14,17,21,22] Noninvasive assessment of CSF disorders in the elderly is performed using cerebral computerized tomography (CT) and MR imaging; however, with more advanced ultrasound equipment, assessment of the third ventricle, the lateral ventricles, and a midline shift has become feasible even in patients with insufficient acoustic bone windows.…”