Dynamic changes in transcranial Doppler ultrasound findings and their value in ischemic stroke evaluation during acute stage

doi:10.3321/j.issn:1673-8225.2005.41.005

Abstract：BACKGROUND: Transcranial Doppler ultrasonography (TCD) can noninvasively detect intracranial arterial blood flow signals and objectively depict changes in cerebral hemodynamics for the benefit of understanding the location, severity, and involved scope of the vascular occlusion and stenosis, as well as the development of collateral circulation and recanalization after occlusion. TCD therefore possesses important significance in the early diagnosis, severity appraisal, and prognostic evaluation of ischemic cere brovascular diseases.OBJECTIVE: To observe the dynamic changes in TCD manifestations during the acute stage of ischemic stroke in comparison with findings by electroencephalogram (EEG), topographic EEG map, and head CT, and explore the value of TCD in early evaluation of ischemic stroke and the association of TCD findings with the other examination modalities and neurological deficit scores to facilitate the treatment.DESIGN: Case-controlled clinical trial.SETTING: The Department of Neurology of the Second Hospital Affiliated to Kunming Medical College.PARTICIPANTS: Between October 2001 and March 2002, 23 patients were admitted to the Department of Neurology of the Second Hospital Affiliated to Kunming Medical College for ischemic stroke. Thirty age-matched healthy subjects for routine physical examination were also included as the control group.after admission and re-examined on days 2, 4, and 7. The normal controls the patients were subjected to bedside EEG examination and topographic with neurological deficit scoring immediately and 3, 4, 7 days after admission. The scores ranged from 45 to 0, and the scores of 0-15 indicated mild neurological deficit, 16-30 moderate and 31-45 serious deficit.ral dysfunction, and results of EEG examination, topographic EEG mapping, and head CT.RESULTS: Totally 23 patients with ischemic stroke and 30 healthy control subjects were enrolled in this study and all were available for result analysis.these patients, significantly higher than the rats by EEG (65.2%), topographic EEG mapping (78.3%) and head CT (17.4%). TCD revealed a reduction in the mean velocity of the blood flow reduced of (34.92±13.25) cm/s in the middle cerebral artery (P ＜ 0.01), but an increase in the anterior ceremetry index of the middle cerebral artery blood flow velocity was positively correlated with the neurological deficit scores (P ＜ 0.01) and the relative power of the slow wave in topographic EEG map (P ＜ 0.01-0.05), but inversely correlated with the relative power of the alpha wave (P ＜ 0.01). The dynamic observation revealed that the blood flow velocity gradually recovered in the middle cerebral artery on affect: d side after treatment, but reduced in the anterior cerebral artery, suggesting the recanalization of the occluded vessels which occurred at different time.CONCLUSION: In the acute stage of ischemic stroke, TCD can be valuable in detecting hemodynamic abnormalities due to cerebral vascular occlusion, with better sensitivity than that of topographic EEG mapping, EEG and head CT. The degree of the abnormalities identified by TCD is associated with the severity of the patients' condition, and dynamic observation with TCD may help assess the vascular recanalization.