Transcranial doppler in acute ischemic stroke of the middle cerebral artery territories

Abstract

We have investigated the reliability of transcranial doppler compared with cerebral angiography in acute ischemic stroke in the middle cerebral artery territories. We studied 48 patients, 28 men and 21 women, mean age 68.1 (range 54–75), observed within 5 h of the onset of ischemic stroke in the middle cerebral artery territory. Ultrasound evaluation (duplex scanner and transcranial doppler) and cerebral angiography were carried out in close sequence immediately after CT scan. CT was repeated by Day 7 to estimate the infarct size: 27/48 patients had intracranial arterial obstructions. An acoustic temporal “window” was not found in 6.25%. Transcranial doppler showed a sensitivity of 80.0% and a specificity of 90.0% compared with cerebral Angiography for patients with patent acoustic temporal “windows”. Accuracy was 79.2%, when patients with no “windows” were included. With respect to intracranial internal carotid artery and middle cerebral artery mainstem, transcranial doppler showed a sensitivity of 95.0%, and a specificity of 92.0%. Including patients with no windows, accuracy was 87.5%. Conclusions: Our data suggest that Transcranial Doppler can be reliably used to demonstrate intracranial internal carotid artery or middle cerebral artery mainstem obstructions in the acute phase of a brain infarction.

Accuracy of Transcranial Doppler Compared With CT Angiography in Diagnosing Arterial Obstructions in Acute Ischemic Strokes

“…Similar results had been obtained previously by Ley-Pozo 29 and Camerlingo 30 in anterior circulation artery occlusions. In posterior circulation arteries, our results are in agreement with the reports by Brandt 31 and Tsivgoulis 32 who found that TCD had lower sensitivity but high specificity in the diagnosis of occlusive disease.…”

“…16,29,30 The main strengths of our study are that it was conducted in a normal clinical setting in all consecutive patients with acute ischemic strokes who had an acoustic window that allowed TCD examination. There was a very little time difference between CTA and PMD-TCD.…”

Prognostic Value of Transcranial Sonography in Acute Stroke Patients

“…After adjustment for age, neurological deficit on admission, CT scan results, and preexisting risk factors, ultrasound findings remained an independent predictor of outcomes. These results are in line with several small ultrasound studies which emphasize ultrasound as a valid predictor of clinical outcome [7,8,9,10,11]. NAIS also highlights the large number of pathological findings seen within the first hours after stroke which often resolve during the further course of disease.…”

Utility of transcranial Doppler ultrasound for the integrative assessment of cerebrovascular function

“…TCD has excellent utility in diagnosis of occlusion within the cerebral vessels with sensitivity and specificity over 90%-particularly in patients where cerebral ischemia is present (Camerlingo et al, 1993). Diagnosis is through absence or a profound reduction of flow at the normal position and depth, and/or consequent lack of signal for the vessels in the immediate vicinity of the occluded region.…”