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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The transcranial Doppler sonographic findings of 40 patients with middle cerebral artery (MCA) territory infarction were compared with those of 40 controls. The results showed that in the group of acute phase patients there was a large reduction of MCA mean flow velocity (Vm) of the infarcted side compared with the normal hemisphere (P < 0.01) and controls (P < 0.05). At the same time the anterior cerebral artery (ACA) Vm rose on both sides (esp. on the infarcted side) in comparison with controls (P < 0.05). The posterior cerebral artery (PCA) Vm did not change significantly (P > 0.05). In the group of chronic phase patients there were changes similar to the group of acute phase patients in MCA Vm and ACA Vm, but not statistically significant. Follow-up TCD examinations were carried out in 8 cases during the acute phase of stroke. We found that the decreased MCA Vm on the infarcted side returned to normal in 4 cases, remained lower in another 2 cases within 4 weeks after onset. The increased MCA Vm on the infarcted side in 2 cases returned to normal within 2 weeks after onset. Various types of TCD findings in patients with MCA occlusion were described and analysed.
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PMID:[A study on middle cerebral artery territory infarction with transcranial Doppler sonography]. 129 Dec 45

During a 6-year-period, in 45 patients the diagnosis of dolichoectatic intracranial arteries was established. Dolichoectasia of the vertebrobasilar system was the most frequent finding (n = 39). Twenty-two patients presented with brain stem ischaemia, and 10 patients had ischaemic hemispheric events. Six patients had symptoms due to compression of cranial nerves. Hydrocephalus was observed once. Peak and mean flow velocities in 39 patients with dolichoectatic basilar arteries as revealed by transcranial Doppler ultrasound were significantly reduced (p less than 0.00001) when compared with an age-adjusted control group of 20 patients without evidence of vertebrobasilar dolichoectasia on angiogram. Non-invasive MR-angiography offered an excellent imaging of the vascular abnormality. The combined use of CT, TCD, MRI and MR-angiography allows reliable non-invasive diagnosis of dolichoectatic intracranial arteries. This condition seems to play an underestimated role in stroke patients, in particular with respect to the vertebrobasilar circulation.
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PMID:Stroke and dolichoectatic intracranial arteries. 135 89

We studied 34 patients with acute ischemic stroke in the territory of the middle cerebral artery (MCA) by three-dimensional transcranial Doppler (TCD-3D). The parameters analyzed were: mean blood flow velocity, systolic and diastolic velocities; indices of pulsatility, hemisphere asymmetry and pulsatility transmission. Of the 34 patients 11 presented marked slowing of flow velocity in the MCA on the infarct side with an asymmetry index (AI) of over 40%, 8 patients with slightly reduced flow velocity in the MCA and an AI of 25-40%, 2 patients in whom there was indirect evidence of collateral circulations in the anterior cerebral artery distribution together with slowing of MCA flow; 5 patients had stenosis of the MCA, 9 patients showed no alterations of the Doppler parameters. The correlation between neurological symptom pattern and AI was significant (r = 0.76). Noninvasive, easy to perform, performable at once and reliable, TCD-3D is a great improvement on traditional transcranial Doppler and is especially useful in assessing the hemodynamics of the cerebral circulation in ischemic stroke.
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PMID:Three-dimensional transcranial Doppler in acute ischemic stroke in the territory of the middle cerebral artery: clinical and CT correlation. 178 32

Describing a case of acute ischemic stroke in the middle cerebral territory, seen on CT scan, the Authors discuss the TCD results.
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PMID:[Transcranial Doppler in a case of stroke in the acute phase: clinical and instrumental correlations]. 208 14

TCD recording of flow velocities in intracranial vessels was first described by Aaslid in 1982. The utility of this instrument becomes more apparent as it is used in different clinical settings and compared with angiographic findings (Figures 1 and 2). Its importance in early detection of vasospasm in subarachnoid hemorrhage is now clearly known; increased flow velocity can be documented prior to neurologic deterioration and thus allow early institution of therapy. In patients with stroke or transient ischemic attack of unclear etiology, especially in blacks, Orientals, or females, who have a higher incidence of intracranial arterial disease, TCD can be a very important noninvasive means for detecting stenosis of intracranial vessels. Its value for assessing collateral circulation, intraoperative monitoring, and measuring CBF is quite promising. Hopefully, through further work with TCD, we will be able to clarify the spectrum of its usages as well as its limitations, though the preliminary data indicate that it should be an important addition to present noninvasive evaluations.
Stroke 1988 Jul
PMID:Transcranial Doppler. 296 90

Carotid atherosclerotic disease is a major source for artery to artery embolism. Stroke incidence highly depends on the degree of carotid stenosis. TCD monitoring for embolic signals may help to identify patients at high risk for an impeding stroke. This study was performed to correlate the degree of carotid stenosis with the occurrence of embolic signals and the clinical outcome. We performed a bilateral simultaneous TCD study on 4 patient groups with unilateral atherosclerotic disease: We studied patients with non-stenotic ICA plaques (n = 21), 50-75% ICA stenosis (n = 20), 75-95% stenosis (n = 22), and occlusion (n = 13). Minimum insonation time was 45 minutes. Embolic signals were not detected in the control group and patients with a non-stenotic ICA lesion, but in 10% of the patients with 50-75% stenosis, 22% of the patients with a high grade stenosis and 39% of the patients with an ICA occlusion. There is a high specificity (92%) and rather low sensitivity (29%) of these microemboli for past clinical events. The occurrence of embolic signals correlated (p < 0.005) with a history of stroke, TIA or RIND. Microemboli detection may be a valuable tool to identify high risk patients.
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PMID:Embolus detection in different degrees of carotid disease. 764 73

rCBF SPECT with 99mTc-HMPAO was performed prospectively in 29 patients (3 controls and 26 stroke patients) as well as TCD studies in 20 patients (3 controls and 17 stroke patients) before and after 1 g i.v. acetazolamide. The sensitivity of rCBF SPECT increased from 62% to 77% after acetazolamide provocation in stroke patients. In patients with a reversible neurological deficit, the sensitivity under resting conditions was 50% which increased to 71%, while in cases with a permanent deficit it increased from 75% to 83%. In the evaluation of the cerebrovascular reserve capacity the results of rCBF SPECT and TCD coincided in 91% of the hemispheres. The correlation was statistically significant.
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PMID:Evaluation of cerebral vasoreactivity by SPECT and transcranial Doppler sonography using the acetazolamide test. 785 20

Patent foramen ovale (PFO) is increasingly recognized in association with cryptogenic stroke. Using transesophageal echocardiography (TEE) and transcranial Doppler sonography with ultrasonic contrast medium (contrast-TCD), we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia. There was a right-left shunt in 50 patients (45%) with TEE. In 31 of 40 patients with stroke of unknown etiology, a PFO was the only detectable finding associated with cerebral ischemia. Using TEE as the "gold standard," the sensitivity of contrast-TCD was 91.3%, specificity 93.8%, and the overall accuracy 92.8%. Contrast-TCD failed to detect a right-left shunt in four patients, but there were four other patients with negative TEE and positive contrast-TCD. We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt. Its advantages are low cost, its ability to detect single contrast-medium embolism, and control of the Valsalva maneuver by observing the decrease of cerebral blood flow. Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source.
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PMID:Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale: experiences with 111 patients. 793 82

We examined 50 ischemic stroke patients and 67 controls free of vascular disease, intra- or extracranial. We assessed all subjects clinically by neurological examination (quantified on the Canadian Neurological Scale or CNS), by three-dimensional transcranial Doppler sonography (TCD-3D) and by computed tomography (CT) within 24 h of the acute event, repeating CT 15 days later. 15 patients also underwent magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). We used the following Doppler parameters: interhemispheric asymmetry index (AI), mean flow velocity (mV) and pulsatility index (PI) for the middle cerebral artery (MCA). The difference between patients and controls on analysis of the variance (ANOVA) in respect of AI was significant: F = 50.8, p < 0.0001. The CNS-AI correlation was equally valid: r = -0.56, p < 0.001. The CNS-CT correlation proved to be highly significant: r = -0.72, p < 0.0001. TCD-3D allowed quantitative evaluation of the hemodynamic changes and of the collateral blood supply and proved to be a sound method for the investigation of ischemic stroke, correlating well with the clinical findings, MRA and lesion size on CT.
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PMID:Acute hemispheric stroke: correlation between three-dimensional transcranial Doppler, MR-angiography, CT and clinical findings. 831 76

The EC-IC Bypass Study Group could not detect any benefit from surgery compared to medical management in the prevention of stroke in 1985 [15]. During the past years surgical revascularization was re-evaluated and considered as an appropriate treatment for a small subgroup of patients with recurrent focal cerebral ischaemia and impaired haemodynamics. This retrospective study examines the long-term benefit and patency rate of bypass. We present a follow-up of 5.6 years of 47 patients, all of whom underwent bypass surgery after 1985. Forty patients suffered recurring transient ischaemic attacks due to uni- or bilateral internal carotid artery occlusion. Examination included neurologic status, TCD with CO2 or Diamox challenge, angiography, CT and SPECT scans. Neurological improvement was seen in 23% of patients with better results after early surgery, a worsening in 22% suffering further ischaemic events on a postoperative average of 2.8 years. Patency rate for vein graft material was 50%, for the STA-MCA procedure 91%. Occlusion of the vein graft occurred on an average after 1.4 years, other anastomosis after 2.7 years. We conclude that only few patients derived long-term benefit from EC-IC bypasses. Functioning of the bypass worsens over time, suggesting a role for surgery predominantly in the first year of ischaemic events due to insufficient collateral supply. Actual indications for bypass surgery may be patients with failure of maximal medical therapy and progressive ischaemia and haemodynamic compromise.
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PMID:Long-term evaluation of EC-IC bypass patency. 889 Sep 90


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