Transcranial Doppler (TCD) was introduced in 1982 to assess intracranial arteries noninvasively, since when it has been widely used to assess and monitor cerebrovascular hemodynamics. The clinical applications of TCD are broadening to include other fields that require monitoring of the cerebral blood flow. TCD has fewer temporal and spatial restrictions than other methods, can be performed on less-compliant patients, and causes no harm to the body. However, its reliance on high levels of examiner skill and experience, as well as a lack of standardized scanning protocols are obstacles that still need to be overcome. In this report we review TCD examination techniques and interpret their findings for several conditions.
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Manual of Transcranial Doppler Ultrasonography Ho Tae JEONG, Soo Na JEON, Sol HAN Korean Journal of Clinical Laboratory Science.2024; 56(3): 277. CrossRef
The Pathophysiology of Syncope and the Role of Transcranial Doppler in its Diagnostic Evaluation Bang-Hoon Cho Journal of Neurosonology and Neuroimaging.2024; 16(2): 51. CrossRef
Success Rate of Transcranial Doppler Scanning of Cerebral Arteries at Different Transtemporal Windows in Healthy Elderly Individuals Mandy Yuen-Man Chan, Yan To Ling, Xiang-Yan Chen, Suk-Tak Chan, Kenneth K. Kwong, Yong-Ping Zheng Ultrasound in Medicine & Biology.2023; 49(2): 588. CrossRef
Background Pulsatility of cerebral arteries and aortic stiffness have been associated with
white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct.
Methods We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate-to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis.
Results Eighty-three patients (56 males, mean age 61.5 ± 11.4) participated in the study. Univariate analysis showed old age and high PI-MCA were significantly correlated with moderate-to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719.
Conclusions PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.
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Distinct association between cerebral arterial pulsatility and subtypes of cerebral small vessel disease Ki-Woong Nam, Hyung-Min Kwon, Yong-Seok Lee, Masaki Mogi PLOS ONE.2020; 15(7): e0236049. CrossRef
Characterizing pulsatility in distal cerebral arteries using 4D flow MRI Tomas Vikner, Lars Nyberg, Madelene Holmgren, Jan Malm, Anders Eklund, Anders Wåhlin Journal of Cerebral Blood Flow & Metabolism.2020; 40(12): 2429. CrossRef
Persistent left superior vena cava (PLSVC) is a common venous anomaly of the thorax and usually drains into the right atrium. Less often it drains into the left atrium and has previously been related to ischemic stroke. We report a case of PLSCV that founded during ischemic
stroke evaluation in a 77-year-old woman which was detected on transesophageal echocardiography (TEE) and transcranial Doppler ultrasonography (TCD) with saline agitated test and computed tomography.
Background: The effects of omega-3 polyunsaturated fatty acids (PUFAs) on cerebral vessels have not been clarified until now. Thus we investigated the efficacy of omega-3 PUFAs supplementation on cerebral blood flow velocity and vascular resistance via transcranial doppler (TCD). Methods: Consecutive twenty patients (13 male and 7 female) with at least 1 cerebrovascular risk factor or a known cerebrovascular disease were enrolled. Patients were treated with omega-3 PUFAs (1 g, two times per day) for 12 weeks. Cerebral blood flow velocity, resistance index, and pulsatile index were checked before and after 12 weeks of treatment using TCD. Results: The change of resistance index in right MCA (from 0.58 ± 0.07 to 0.55 ± 0.07, p = 0.042) and left PCA (from 0.56 ± 0.07 to 0.53 ± 0.06, p = 0.037) showed significant improvement after 12 weeks of omega-3 PUFAs treatment. The changes in other vessels, however, failed to show any significant changes compared to the baseline. Conclusions: Omega-3 PUFAs treatment showed feasible efficacies for cerebral vascular resistances in this open label trial. To confirm these results, larger samples of patients and longer period of follow-up is warranted.
Dignosis of migraine is only based on the medical history, and objective methods to aid the clinical diagnosisare absent. Although transcranial Doppler ultrasonography (TCD) abnormalities in headache-free migraineurs have been reported previously, diagnostic criteria for migraine is still lacking and this may limit the practication of TCD for migraine. we prospectively studied several abnormal TCD indices in interictal migraineurs and their sensitivity and specificity to define the optimal diagnostic criteria. Young (20 yrs
Transcranial doppler ultrasonography (TCD) is a new, non-invasive and easily applicable method to evaluate cerebral hemodynamics. Last 10 years, its use in Korea has been dramatically expanded, but the qualification of TCD laboratory has yet to be settled. Since duplex sonography is seldom used in Korea, we have to depend totally on TCD to evaluate cerebral hemodynamic changes. Thus, ll of the available data from every detectabler cerebral arteries has to be obtained for accurate interpretation of TCD measurements. Moreover, flow direction and wave form should be concerned in addition to the flow velocity. In this article, I present technique to measure the anterior, meddle and posterior cerebral arteries, the internal carotid artery siphon and at cervical level, and the vertebral and the basilar artery, and normal values for these measurements which is essential for the adequate interpretation.
Vasoconstriction of intracerebral arteries is the leading cause of delayed cerebral infarction and mortality following aneurysmal subarachnoid hemorrhage. Transcranial Doppler studies show and increase in the flow velocities of basal cerebral arteries, which usually start around day 4 following a subarachnoid hemorrhage, and peaking by days 7 to 14. Angiographic studies confirm the presence of at least some degree of MCA vasospasm when the flow velocities are higher than 100 cm/sec. Mean velocities in the 120 to 200 cm/sec range correspond to 25 to 50% luminal narrowing. MCA and ACA vsospasm is detected with around 90% specificity. Sensitivity is 80% and 50% respectively. A 200cm/sec threshold and rapid flow velocity increase exceeding 50 cm/sec on consecutive days, has been associated with subsequent infarction. Transcranial Doppler is also used to monitor the effects of endovascular treatment of vasospasm. Flow velocities decrease following successful angioplasty or papaverine infusion. Overall, transcranial Doppler studies are considered to have acceptable accuracy for the evaluation of vasospasm in aneurysmal subarachnoid hemorrhage, with limitations that have to be taken into consideration in the clinical setting.
Transcranial Doppler(TCD) is an important diagnostic tool for evaluating the patients with stroke. It has some advantages and unique role when compared with other neuroimaging modalities. Recent development f transcranial color-coded Doppler(TCD) improves the limitation and pitfalls of TCD. The current indications of TCD are as follows: 1. Screening and evaluation of the intracranial major vessels 2. early detection and follow-up of vasospasm due to SAH 3. emboli detection (high-imtensity transient signals, HITs) 4. dignosis and follow-up of subclavian steal 5. evaluation of intracranial collaterals when the extracranial ICA has severe stenosis or occlusion 6. evaluation of cerebral perfusion pressure (intracranial pressure) 7. evaluation of arteriovenous malformation 8. diagnosis and follow-up of arterial dissenction 9. diagnosis and follow-up of venous sinus thrombosis (experimental)
Background : Syncope was defined as transient loss of consciousness and postural tone. The mechanisms of changes in cerebral hemodynamics during syncope have not been fully evaluated. Transcranial Doppler Ultrasonography can continuously monitor the changes in cerebral hemodynamics during head-up tilt (HUT). TCD could reveal the different patterns of changes in cerebral hemodynamics during syncope. Syncope without hypotension or bradycardia could be detected by TCD. We investigated the changes in cerebral blood flow velocity during HUT using TCD in 33 patients with a history of recurrent syncope or presyncope of unknown origin. Methods & Results : The positive responses were defined as presyncope or syncope with hypotension, bradycardia, or both. During HUT without isoproterenol infusion, there were a 86?3% drop in DV and a 41?4% drop in SV in 5 patients with positive reponses, and mean changes in those were less than 10% in patients with negative reponses ( p=.00, p=.00). During HUT with isoproterenol infusion, TCD showed a 80?8% drop in diastolic velocity in 14 patients with positive reponses, and a 47?0% drop in that in patients with negative reponses (p=.00), however the change in systolic velocity did not differ. TCD showed three patterns during positive responses; loss of all flow, loss of end diastolic flow, and a decrease in diastolic velocity. Loss of consciousness occurred in the patients with loss of all flow or end-diastolic flow during positive reponses. Conclusions : TCD shows different patterns of changes in cerebral hemodynamics during HUT. TCD can be used to investigate the pathophysiology of neurocardiogenic syncope
The most significant factor in pathogenesis of vascular headaches like migraine and cluster headache is dynamic changes of diameters of the cerebral arteries. TCD is a valuable noninvasive tool to assess the cerebral hemodynamic status by measuring the flow velocities of the intracranial cerebral arteries around the circle of Willis. TCD can evaluate flow velocities and vasoreactivity of the patients with a vascular headache during the ictal phase as well as during intericatal phase. Distribution of the changes recorded differ between types of headaches nd also between the major ictal symptoms. The Changes suggest the presence of prolonged vasospasm interictally and more marked relaxation of the cerebral arteries. TCD can be used to monitor the long-term clinical course of patients with vascular headache by correlation the symptomatic improvement and TCD data before and after long-term pharmacological prophylactic treatments. During the ictal phases large intervention. The results may be used in selecting and evaluating the agents for abortive therapy for acute attacks. In conclusion TCD can quantitatively evaluate vascular headaches when making diagnosis and classification and can provide guidelines to choose more individualized therapeutic options for both acute and long-term treatment
Background Migraine patients can be sensitive to external or internal stimuli, such as light, noise, or hormonal changes.Using transcranial Doppler ultrasonography (TCD) with breath-holding method, we evaluated the changes of cerebrovascularreactivity (CVR) to hypercapnia in women with migraine without aura between fasting and postprandial period. Methods:Twelve women with migraine without aura and the same number of age and sex-matched healthy controls with no significanthistory of headache participated in this study. Using TCD examinations, we studied mean flow velocity in middle cerebralartery with better temporal window. Each subject was examined consecutively before and after a standard meal, togetherwith serum glucose level and blood pressure. CVR was evaluated with breath-holding index (BHI). Results: Postprandial-BHI(mean+SD) was significantly higher than fasting-BHI (mean+SD) in patients group but not in controls (in patient group;postprandial-BHI=1.38, fasting-BHI=1.08, in control group; postprandial-BHI=1.25, fasting-BHI=1.18, P=0.021 and 0.239,respectively). After meal, serum glucose level was significantly enhanced but blood pressure was not in both groups. Serumglucose level of patients showed a tendency of mild positive correlation with BHIs (
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