BACKGROUND: Transcranial Doppler (TCD) ultrasound can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with cerebral infarction. METHODS: Patients admitted between April 2006 and June 2007 with ischemic stroke of less than 24 h were subjected to a protocol consisting of non-contrast brain CT, computed tomography angiography, diffusion-weighted magnetic resonance imaging and then TCD within the following 6 h by an observer blinded to the results of imaging studies. RESULTS: Seventy-nine patients were included. The imaging protocol was performed 457 (+/-346) min after stroke symptoms and TCD after 572 (+/-376) min. TCD provided additional information in 28 cases (35.4%, 95% CI 25.7-46.4). More that one piece of additional information was obtained in 6 patients. The most frequent additional information was collateral pathways. Multivariate analysis demonstrated that intracranial vessel occlusion was the variable most associated with additional information. In 7 patients (8.8%, 95% CI 4.3-17.1), additional information changed management: in 4 an additional angiography was performed, in 2 patients angiography was suspended and in 1 aggressive neurocritical care was indicated. Patients with NIHSS >10 were significantly more likely to have their initial treatment changed (p = 0.004). CONCLUSIONS: TCD can provide additional information to a multimodal acute ischemic stroke imaging protocol in a third of patients. This can result in changes in the management in some of these patients. Copyright 2010 S. Karger AG, Basel.
BACKGROUND: Transcranial Doppler (TCD) ultrasound can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with cerebral infarction. METHODS:Patients admitted between April 2006 and June 2007 with ischemic stroke of less than 24 h were subjected to a protocol consisting of non-contrast brain CT, computed tomography angiography, diffusion-weighted magnetic resonance imaging and then TCD within the following 6 h by an observer blinded to the results of imaging studies. RESULTS: Seventy-nine patients were included. The imaging protocol was performed 457 (+/-346) min after stroke symptoms and TCD after 572 (+/-376) min. TCD provided additional information in 28 cases (35.4%, 95% CI 25.7-46.4). More that one piece of additional information was obtained in 6 patients. The most frequent additional information was collateral pathways. Multivariate analysis demonstrated that intracranial vessel occlusion was the variable most associated with additional information. In 7 patients (8.8%, 95% CI 4.3-17.1), additional information changed management: in 4 an additional angiography was performed, in 2 patients angiography was suspended and in 1 aggressive neurocritical care was indicated. Patients with NIHSS >10 were significantly more likely to have their initial treatment changed (p = 0.004). CONCLUSIONS:TCD can provide additional information to a multimodal acute ischemic stroke imaging protocol in a third of patients. This can result in changes in the management in some of these patients. Copyright 2010 S. Karger AG, Basel.
Authors: Alejandro M Brunser; Gabriel Cavada; Paula Muñoz Venturelli; Verónica Olavarría; Alexis Rojo; Juan Almeida; Violeta Díaz; Arnold Hoppe; Pablo Lavados Journal: Neuroradiology Date: 2018-05-22 Impact factor: 2.804