From the Guidelines
Cerebral sonography, particularly transcranial color-coded duplex sonography (TCCS), is a valuable tool in the assessment of intracranial arteries in patients with acute stroke, offering advantages over transcranial Doppler sonography in identifying blood flow in specific intracranial vessel segments and detecting vessel pathologies 1.
Key Points
- TCCS provides several advantages compared with transcranial Doppler sonography, including more reliable identification of blood flow in specific intracranial vessel segments and more detailed allocation of vessel pathologies 1.
- The use of TCCS in studies on recanalization therapies allows for the assessment of occlusive disease of the main segments of the intracranial arteries, evaluation of early recanalization, and guidance of therapeutic decisions 1.
- Ultrasound evaluation, including TCCS, provides important prognostic information in the acute stage of stroke, and its application can be complemented by other imaging methods such as CT, MRI, and angiography for comprehensive patient assessment 1.
Clinical Application
- In clinical practice, TCCS can be used as a bedside tool to identify patients with compromised intracranial hemodynamics, aiding in the diagnosis and follow-up of acute stroke patients 1.
- For patients with manifestations suggestive of hemispheric transient ischemic attack (TIA), a CT or MRI scan of the head is recommended in the initial diagnostic evaluation to exclude rare lesions and to show areas of brain infarction 1.
- Transcranial Doppler is a complementary examination in patients with a recent TIA, providing additional information on patency of cerebral vessels, recanalization, and collateral pathways 1.
Recommendations
- The most recent and highest quality study recommends the use of TCCS in the assessment of intracranial arteries in patients with acute stroke, given its advantages over other ultrasound methods 1.
- A comprehensive approach to stroke diagnosis and management should include a combination of clinical assessment, laboratory tests, and imaging studies, with TCCS being a valuable component of this approach 1.
From the Research
Cerebral Sonography
- Cerebral sonography, particularly Transcranial Doppler (TCD) and carotid duplex ultrasound (CD), plays a crucial role in the evaluation of stroke patients 2.
- TCD is a valid, safe, and inexpensive technique that can assess recanalized vessels and reperfused tissue in real-time at the bedside, making it an essential tool in acute stroke care 3.
- The use of TCD and CD in the Emergency Service can help stroke neurologists rapidly evaluate stroke patients, determine the likely mechanism of stroke, and decide on reperfusion and secondary prevention strategies 2.
Applications of Transcranial Doppler
- TCD can be used to elucidate stroke mechanisms, plan and monitor treatment, and determine prognosis in acute ischemic stroke 4.
- TCD can detect intracranial arterial disease, which is an important cause of ischemic stroke, with a fair amount of sensitivity and specificity 4.
- TCD can also monitor blood flow in a blood vessel over prolonged periods, allowing for the detection of microembolic signals in acute ischemic stroke, carotid artery disease, and atrial fibrillation 4.
Cerebral Autoregulation and Hemodynamics
- Cerebral autoregulation may become impaired after stroke, and TCD in combination with continuous blood pressure measurements can provide noninvasive continuous bedside investigation of cerebral autoregulation 5.
- TCD studies have shown impairment of cerebral autoregulation in various subtypes of ischemic stroke, which can be related to neurological deterioration and poor outcome 5.
- TCD can also demonstrate hemodynamic changes caused by intracerebral hemorrhage, although the severity of these changes may not correlate with the volume of the hemorrhage in the acute stage 6.