Transcranial color duplex sonography in childhood and adolescence. Age dependence of flow velocities and waveform parameters.

Schöning, M.; Staab, Michael E.; Walter, Jochen; Niemann, Gerhard

doi:10.1161/01.str.24.9.1305

Cited by 57 publications

(41 citation statements)

References 11 publications

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“…10,18 Two other reports, however, did show these differences, 23,24 which were explained by sex differences in cerebrovascular resistance and vascular reactivity. In children with SCD, altered resistance and reactivity may counterbalance sex differences in Doppler parameters.…”

Section: Discussionmentioning

confidence: 89%

“…In healthy children, flow velocities in the MCA and ICA are lower in older children, 10,18 probably as a result of proportional growth of both arteries along with body development. 19 The slope of age dependency however, is flatter in children with SCD.…”

Section: Discussionmentioning

confidence: 98%

“…31 Higher flow-velocity asymmetry was reported in healthy white children, almost similar to asymmetry observed in our group. 10 The threshold of 15% of interhemispheric differences as a reference tolerance limit, therefore, should no longer be applied to the individual child with SCD for differentiation of hyperemia from arterial stenosis.…”

Section: Tolerance Intervals For Interhemispheric Differencesmentioning

confidence: 99%

“…1,9 Substantial side-to-side differences in flow velocities in individual children without any arterial stenosis, 10 however, indicate that extrapolation of average group symmetry in flow velocities to individual children with SCD may not be correct.…”

mentioning

confidence: 99%

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Sickle Cell Disease: Reference Values and Interhemispheric Differences of Nonimaging Transcranial Doppler Blood Flow Parameters

Arkuszewski¹,

Krejza²,

Chen³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:TCD screening is widely used to identify children with SCD at high risk of stroke. Those with high mean flow velocities in major brain arteries have increased risk of stroke. Thus, our aim was to establish reference values of interhemispheric differences and ratios of blood flow Doppler parameters in the tICA, MCA, and ACA as determined by conventional TCD in children with sickle cell anemia.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 98%

Section: Tolerance Intervals For Interhemispheric Differencesmentioning

confidence: 99%

mentioning

confidence: 99%

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Sickle Cell Disease: Reference Values and Interhemispheric Differences of Nonimaging Transcranial Doppler Blood Flow Parameters

Arkuszewski¹,

Krejza²,

Chen³

et al. 2011

AJNR Am J Neuroradiol

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“…Of concern is that baseline flow velocities in children are higher than in adults. 3,4,44,48 O'Brien et al, 35 examining CV in children after traumatic brain injuries, reported an overall 63.7% incidence of CV by adult TCD criteria. The authors also noted that since normal flow velocities are higher in children than in adults, the adult diagnostic criteria used in their study may have overestimated the true incidence of CV in their pediatric head trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

Moftakhar

Cooke

Fullerton

et al. 2015

PED

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OBJECT Although the development and prevalence of cerebral vasospasm (CV) has been extensively investigated in adults, little data exist on the development of CV in children. The authors hypothesized that even though children have highly vasoreactive arteries, because of a robust cerebral collateral blood flow, they rarely develop symptomatic CV. METHODS The authors retrospectively reviewed their university hospital's neurointerventional database for children (that is, patients ≤ 18 years) who were examined or treated for aneurysmal or traumatic subarachnoid hemorrhage (SAH) during the period 1990–2013. Images from digital subtraction angiography (DSA) were analyzed for the extent of CV and collateralization of the cerebral circulation. Results from transcranial Doppler (TCD) ultrasonography were correlated with those from DSA. Cerebral vasospasm on TCD ultrasonography was defined according to criteria developed for adults. Clinical outcomes of CV were assessed with the pediatric modified Rankin Scale (mRS). RESULTS Among 37 children (21 boys and 16 girls ranging in age from 8 months to 18 years) showing symptoms of an aneurysmal SAH (comprising 32 aneurysms and 5 traumatic pseudoaneurysms), 17 (46%) had CV confirmed by DSA; CV was mild in 21% of these children, moderate in 50%, and severe in 29%. Only 3 children exhibited symptomatic CV, all of whom had poor collateralization of cerebral vessels. Among the 14 asymptomatic children, 10 (71%) showed some degree of vessel collateralization. Among 16 children for whom TCD data were available that could be correlated with the DSA findings, 13 (81%) had CV according to TCD criteria. The sensitivity and specificity of TCD ultrasonography for diagnosing CV were 95% and 59%, respectively. The time to CV onset detected by TCD ultrasonography was 5 ± 3 days (range 2–10 days). Twenty-five (68%) of the children had good long-term outcomes (that is, had mRS scores of 0–2). CONCLUSIONS Children have a relatively high incidence of angiographically detectable, moderate-to-severe CV. Children rarely develop symptomatic CV and have good long-term outcomes, perhaps due to robust cerebral collateral blood flow. Criteria developed for detecting CV with TCD ultrasonography in adults overestimate the prevalence of CV in children. Larger studies are needed to define TCD ultrasonography–based CV criteria for children.

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Determinants of resting cerebral blood flow in sickle cell disease

et al. 2016

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Stroke is common in children with sickle cell disease and results from an imbalance in oxygen supply and demand. Cerebral blood flow (CBF) is increased in patients with sickle cell disease to compensate for their anemia, but adequacy of their oxygen delivery has not been systematically demonstrated. This study examined the physiological determinants of CBF in 37 patients with sickle cell disease, 38 ethnicity matched control subjects and 16 patients with anemia of non-sickle origin. Cerebral blood flow was measured using phase contrast MRI of the carotid and vertebral arteries. CBF increased inversely to oxygen content (r2 = 0.69, p < 0.0001). Brain oxygen delivery, the product of CBF and oxygen content, was normal in all groups. Brain composition, specifically the relative amounts of grey and white matter, was the next strongest CBF predictor, presumably by influencing cerebral metabolic rate. Grey matter/white matter ratio and CBF declined monotonically until the age of 25 in all subjects, consistent with known maturational changes in brain composition. Further CBF reductions were observed with age in subjects older than 35 years of age, likely reflecting microvascular aging. On multivariate regression, CBF was independent of disease state, hemoglobin S, hemoglobin F, reticulocyte count and cell free hemoglobin, suggesting that it is regulated similarly in patients and control subjects. In conclusion, sickle cell disease patients had sufficient oxygen delivery at rest, but accomplish this only by marked increases in their resting CBF, potentially limiting their ability to further augment flow in response to stress.

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Transcranial color duplex sonography in childhood and adolescence. Age dependence of flow velocities and waveform parameters.

Cited by 57 publications

References 11 publications

Sickle Cell Disease: Reference Values and Interhemispheric Differences of Nonimaging Transcranial Doppler Blood Flow Parameters

Sickle Cell Disease: Reference Values and Interhemispheric Differences of Nonimaging Transcranial Doppler Blood Flow Parameters

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

Determinants of resting cerebral blood flow in sickle cell disease

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