Evaluation of right-to-left shunt on contrast-enhanced transcranial Doppler in patent foramen ovale-related cryptogenic stroke: Research based on imaging

BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using contrast-enhanced transcranial Doppler(c-TCD)are numerous.According to the time phase and number of microbubbles detected on c-TCD,RLS can be classified and graded.We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIM To explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODS We retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital.In total,111 PFO-related CS patients were divided according to whether RLS was permanent(microbubbles detected both at resting state and after the Valsalva maneuver)or latent(microbubbles detected only after the Valsalva maneuver)on c-TCD.Each group was subdivided into small,mild and large RLS according to the grade of shunt on c-TCD.A normal control group was composed of 33 patients who suffered from simple dizziness.Intragroup and intergroup differences were analyzed in terms of clinical,laboratory and diffusion-weighted imaging lesion characteristics.The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTS In 111 patients with PFO-related CS,68 had permanent RLS and 43 had latent RLS.Clinical characteristics and laboratory tests were not significantly different among the permanent RLS,latent RLS and normal control groups.The proportion of patients with multiple territory lesions in the permanent RLS group(50%)was larger than that in the latent RLS group(27.91%;P=0.021).Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group(30.23%vs 8.82%,P=0.004).Permanent-large and latent-large RLS were both more likely to be related to multiple(P_(trend)=0.017 and 0.009,respectively),small(P_(trend)=0.035 and 0.006,respectively)and cortical(P_(trend)=0.031 and 0.033,respectively)lesions.The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography(r=0.758,P<0.001).CONCLUSION Distribution of the infarct suggested the possible type of RLS.Multiple,small and cortical infarcts suggest large RLS induced by a large PFO.

Nitrogen monoxide vector of ultrasonic atomizing inhalation improves vertebro-basilar artery insufficiency Hemodynamic changes are detected by transcranial Doppler test

BACKGROUND： Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide （NO） in vivo. OBJECTIVE： To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency （VBI） through transcranial Doppler （TCD） detection and serum NO content and indirect effect of TCD on cerebral blood flow changes. DESIGN： Randomized grouping and controlled clinical study. SETTING： Department of Neurology, the Fourth People＇s Hospital of Jinan. PARTICIPANTS： A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People＇s Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confumed consent. They were randomly divided into low-dose treatment group （n =60）, high-lose treatment group （n =30） and control group （n =40）. METHODS： Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition, ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment. According to the TCD test, VBI patients were divided into two groups （high-low flow velocity）. The vertebral artery （VA） and basal artery （BA） of left or right sides were detected by 2 Hz detector via occipital window. MAIN OUTCOME MEASURES： ①Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD before treatment, after treatment for one course; ②content of serum NO indirectly measured by using nitric acid disoxidation technique. RESULTS： All 130 VBI patients were involved in the final analysis. ①Changes of hemodynamic indexes： Systolic phase of VA and diastole phase of BA were higher in low-dose treatment group than that in the control group after first treatment, and there was significant difference （P 〈 0.05）; meanwhile, systolic phase and diastole phase of VA and systolic phase of BA were also higher in treatment group than that in the control group after one course （P 〈 0.05）. However, both systolic phase and diastole phase of VA and BA were lower in high-dose treatment group than that in the control group after first treatment and one course, and there was significant difference （P 〈 0.05）. ②Content of serum NO： After first treatment, there was no significant difference between low-dose treatment group and high-dose treatment group （P 〉 0.05）; but both groups were higher than control group, and there was significant difference （P 〈 0.05, 0.01）. CONCLUSION： NO vector of ultrasonic atomizing inhalation can improve VBI so as to improve cerebral blood-supply state.

Carotid Doppler and transcranial Doppler in diagnosing transient ischemic attack: A healthy control

BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.

Comparison of detection results of hypoxic-ischemic encephalopathy at different degrees in infant patients between brain electrical activity mapping, transcranial Doppler sonography and computer tomography examinations

BACKGROUND： It has been proved that brain electrical activity mapping （BEAM） and transcranial Doppler （TCD） detection can reflect the function of brain cell and its diseased degree of infant patients with moderate to severe hypoxic-ischemic encephalopathy （HIE）. OBJECTIVE： To observe the abnormal results of HIE at different degrees detected with BEAM and TCD in infant patients, and compare the detection results at the same time point between BEAM, TCD and computer tomography （CT） examinations. DESIGN ： Contrast observation SETTING： Departments of Neuro-electrophysiology and Pediatrics, Second Affiliated Hospital of Qiqihar Medical College. PARTICIPANTS： Totally 416 infant patients with HIE who received treatment in the Department of Newborn Infants, Second Affiliated Hospital of Qiqihar Medical College during January 2001 and December 2005. The infant patients, 278 male and 138 female, were at embryonic 37 to 42 weeks and weighing 2.0 to 4.1 kg, and they were diagnosed with CT and met the diagnostic criteria of HIE of newborn infants compiled by Department of Neonatology, Pediatric Academy, Chinese Medical Association. According to diagnostic criteria, 130 patients were mild abnormal, 196 moderate abnormal and 90 severe abnormal. The relatives of all the infant patients were informed of the experiment. METHOOS： BEAM and TCD examinations were performed in the involved 416 infant patients with HIE at different degrees with DYD2000 16-channel BEAM instrument and EME-2000 ultrasonograph before preliminary diagnosis treatment （within 1 month after birth） and 1,3,6,12 and 24 months after birth, and detected results were compared between BEAM, TCD and CT examinations. MAIN OUTCOME MEASURES： Comparison of detection results of HIE at different time points in infant patients between BEAM. TCD and CT examinations. RESULTS： All the 416 infant patients with HIE participated in the result analysis. （1） Comparison of the detected results in infant patients with mild HIE at different time points after birth between BEAM, TCD and CT examinations： BEAM examination showed that the recovery was delayed, and the abnormal rate of BEAM examination was significantly higher than that of CT examination 1 and 3 months after birth [55.4%（72/130）vs. 17.0% （22/130 ）,x^2=41.66 ;29.2% （ 38/130 ） vs. 6.2% （ 8/130 ）, x^2=23.77, P 〈 0.01 ], exceptional patients had mild abnormality and reached the normal level in about 6 months. TCD examination showed that the disease condition significantly improved and infant patients with HIE basically recovered 1 or 2 months after birth, while CT examination showed that infant patients recovered 3 or 4 months after birth. （2） Comparison of detection results of infant patients with moderate HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination 1,3,6 and 12 months after birth [90.8% （178/196）,78.6% （154/196）,x^2=4.32,P 〈 0.05;64.3% （126/196）,43.9% （86/196） ,x^2=16.44 ;44.9% （88/196） ,22.4% （44/196）,x^2=22.11 ;21.4% （42/196）, 10.2% （20/196）,x^2=9.27, P 〈 0.01]. BEAM examination showed that there was still one patient who did not completely recovered in the 24^th month due to the relatives of infant patients did not combine the treatment,. TCD examination showed that the abnormal rate was 23.1%（30/196）in the 1^st month after birth, and all the patients recovered to the normal in the 3^rd month after birth, while CT examination showed that mild abnormality still existed in the 24^th month after birth （1.0% ,2/196）. （3） Comparison of detection results of infant patients with severe HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination in the 1^st, 3^rd, 6^th and 12^th months after birth[86.7% （78/90）,44.4% （40/90）,x^2=35.53;62.2% （56/90）,31.1% （28/90）,x^2=17.51 ;37.8% （34/90）,6.7% （6/90）, x^2=27.14, P 〈 0.01]. BEAM examination showed that mild abnormality still existed in 4 infant patients in the 24^th month after birth. TCD examination showed that the abnormal rate was 11.1% （10/90） in the 3^rd month after birth, and all the infant patients recovered in the 6^th month after birth. CT examination showed that the abnormal rate was 6.7%（6/90） in the 12^th month after birth, and all of infant patients recovered to the normal in the 24^th month after birth.CONCLUSION ： BEAM is the direct index to detect brain function of infant patients with HIE, and positive reaction is still very sensitive in the tracking detection of convalescent period. The positive rate of morphological reaction in CT examination is superior to that in TCD examination, and the positive rate is very high in the acute period of HIE in examination.

Evaluation of Early Acute Cerebral Infarction with Transcranial Doppler

Objective:For patients with early acute cerebral infarction(ACI),transcranial Doppler ultrasound was used in the clinical examination,and its application effect was observed and analyzed.Methods:This study was carried out between October 2018 and October 2019.50 patients with ACI included as the research object was evaluated by transcranial Doppler and CT examination,and the application of the two examination methods was compared.Results:The results of transcranial Doppler examination showed that the abnormal rate of blood flow velocity and the ratio of both sides(VACA)in patients with early ACI was higher than that of CT examination.Conclusion:With the impact on the location and area of vascular occlusion in patients,VACA can effectively reflect the status and effectiveness of the collateral circulation function of the patient’s pia vessels during cerebral infarction.

a Transcranial Doppler Study of Locally Using Dexamethasone after Brain Injury in Rabbits

Objective To explore the effect of locally using dexamethasone on the blood flow velocity in the middle cerebral artery(FVmca) and cerebral edema after brain injury. Methods 20 rabbits were classified to 2 groups, group A( the control group) and B (the treated group). An experimental rabbit model was conducted to contusion by bone window plasty with extradural hitting. Group B was treated by locally infiltrating of dexamethasone at equidistance to lesions. Group A was given normal saline the same way as Group B. The changes of FVmca using trans－cranial Doppler and moisture in brain tissues were observed. Results The normal value of FVmca was (31.8± 4.5)cm/s, while the value of FVmca in group A and B were (15.4± 3.9)cm/s and (22.1± 3.5)cm/s separately.Water content in damaged hemisphere in Group A and B were (81.54± 0.55)％ and (79.35± 0.50)％ respectively. There was a significant difference between the 2 groups (P<0.05). The levels of FVmca in group A and B were lower than that of control and there was also a significant difference between group A and B (P<0.05).Conclusions FVmca decreased and the brain moisture increased after brain injury while FVmca increased and the brain moisture reduced after treatment with dexamethasone. It demonstreated that local treatment of dexamethasone had an obvious therapeutical effect on brain injury.

Microembolic signal detection by transcranial Doppler: Old method with a new indication

Transcranial Doppler(TCD) is useful for investigation of intracranial arterial blood flow and can be used to detect a real-time embolic signal. Unfortunately, artefacts can mimic the embolic signal, complicating interpretation and necessitating expert-level opinion to distinguish the two. Resolving this situation is critical to achieve improved accuracy and utility of TCD for patients with disrupted intracranial arterial blood flow, such as stroke victims. A common type of stroke encountered in the clinic is cryptogenic stroke(or stroke with undetermined etiology), and patent foramen ovale(PFO) has been associated with the condition. An early clinical trial of PFO closure effect on secondary stroke prevention failed to demonstrate any benefit for the therapy, and research into the PFO therapy generally diminished. However, the recent publication of large randomized control trials with demonstrated benefit of PFO closure for recurrent stroke prevention has rekindled the interest in PFO in patients with cryptogenic stroke. To confirm that emboli across the PFO can reach the brain, TCD should be applied to detect the air embolic signal after injection of agitated saline bubbles at the antecubital vein. In addition, the automated embolic signal detection method should further facilitate use of TCD for air embolic signal detection after the agitated saline bubbles injection in patients with cryptogenic stroke and PFO.

TRANSCRANIAL DOPPLER CHARACTERISTICS IN PERSISTENT VEGETATIVE STATUS,LOCKED-IN SYNDROME AND BRAIN DEATH

Aim. Comparison of the trascranial Doppler (TCD) characteristics of cerebral circulation in persistent vegetative status (PVS), locked in syndrome and brain death patients. Methods. Using TCD ultrasound to detect the flow velocity and waveform patterns of middle cerebral artery (MCA) and basilar artery (BA) in patients with PVS, locked in syndrome and brain death. Results. The mean velocities of middle cerebral artery (Vmca) and basilar artery (Vba) were 30.0cm/s and 24.3cm/s in PVS patients respectively, which decreased 45.0% and 14.4% in comparing with normal value. For patients with locked in syndrome, Vmca and Vba were 49.7cm/s and 9.8cm/s, which decreased 5.0% and 61.7% than the normal value respectively. These results showed that the decrease of anterior circulation was predominant in PVS, and the decrease of posterior circulation was predominant in locked in syndrome. A unique diastolic reverse flow, short peak systolic wave or undetectable flow signal in middle cerebral artery were predominant in brain death patients, which was completely different from that of either PVS or locked in syndrome. Conclusion. TCD was a valuable tool in distinguishing PVS, locked in syndrome and brain death patients according to the differences in velocities and patterns of anterior and posterior cerebral arteries.

Transcranial Doppler ultrasonography: From methodology to major clinical applications

Non-invasive Doppler ultrasonographic study of cerebral arteries [transcranial Doppler(TCD)] has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency(≤ 2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays the most widespread indication for TCD in outpatient setting is the research of right to left shunting, responsable of so called "paradoxical embolism", most often due to patency of foramen ovale which is responsable of the majority of cryptogenic strokes occuring in patients younger than 55 years old. TCD also allows to classify the grade of severity of such shunts using the so called "microembolic signal grading score". In addition TCD has found many useful applications in neurocritical care practice. It is useful on both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoidal haemorrhage(caused by aneurysm rupture or traumatic injury), traumatic brain injury, brain stem death. It is used also to evaluate cerebral hemodynamic changes after stroke. It also allows to investigate cerebral pressure autoregulation and for the clinical evaluation of cerebral autoregulatory reserve.

Transcranial Doppler Ultrasonography to Prevent Cerebrovascular Accident in Children with Sickle-Cell Disease

Sickle-cell disease (SCD) is the most common cause of ischemic stroke in children and it happens in about 11% of patients between the age of 2 and 20 years old. About 7% of the world population is affected by hemoglobin disorders, mostly sickle cell anemia. SCD has a high prevalence in the population of African offspring and it is a public health problem in Brazil that affects more than 30,000 million people. Prevention of primary stroke might be feasible with a way to identify children at greatest risk. Transcranial Doppler Ultrasonography (TCD) to SCD patients can be a valuable service that results in a significant decrease of first stroke rates. In this work, we present a review about TCD as an effective strategy to detect children with SCD who are at risk for stroke.

Clinical, brain electric earth map, endothelin and transcranial ultrasonic Doppler findings after hyperbaric oxygen treatment for severe brain injury

目的 探讨高压氧治疗重型颅脑损伤的疗效及机制。方法 重型颅脑损伤患者 35例为治疗组 ,2 0例为对照组 ,观察高压氧治疗前后临床 (GCS)、脑电地形图 (BEAM)、血内皮素 (ET)、经颅多普勒超声 (TCD)及预后 (GOS)的变化。结果 治疗组患者经高压氧治疗后临床 (GCS)、脑电地形图及预后均明显改善 ,与对照组相比有统计学意义。高压氧治疗 1个疗程后 ,治疗组血内皮素由 91 2 4± 12 18ng/L下降到 6 8 88± 14 37ng/L(P <0 0 1) ;经颅多普勒超声示大脑中动脉Vm也由 6 4 2± 4 8cm/s下降到 51 6± 4 2cm/s(P <0 0 1) ;同时 ,大脑中动脉VsPI也明显下降。统计学有显著性意义 (P <0 0 1)。结论 高压氧治疗能够明显改善重型颅脑损伤患者的临床、脑电地形图及预后 ,并且通过降低急性期血内皮素、改善大脑中动脉血流速度及血管阻力来改善重型颅脑损伤后脑血管痉挛及脑缺血缺氧。同时 ,降低颅内压是高压氧治疗重度颅脑损伤的重要机制之一。

Monitoring of antegrade selective cerebral perfusion for aortic arch surgery with transcranial Doppler ultrasonography and near-infrared spectroscopy

Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses Methods In twenty two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD) During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO 2) using dual wavelength spatially resolved near infrared spectroscopy Results All patients experienced an uneventful recovery Flow in the middle cerebral artery became undetectable at ASCP < 5?ml·kg 1 ·min 1 , so adjustments from a 15-20?ml·kg 1 ·min 1 baseline were used to maintain rSO 2 above 50% Furthermore, ASCP flow was highly correlated ( P <0 01) with both peak middle cerebral artery velocity and rSO 2 ( r =0 86 and 0 96, respectively) Conclusion Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort

Clinical utilization of microembolus detection by transcranial Doppler sonography in intracranial stenosis-occlusive disease

Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler （TCD） sonography in intracranial stenosis-occlusive disease. Data sources All related articles in this review were mainly searched from PubMed published in English from 1996 to 2012 using the terms of microembolic signal, transcranial Doppler, intracranial stenosis, stroke. Study selection Original articles and reviews were selected if they were related to the clinical utilization of microembolus detection in intracranial stenosis-occlusive disease. Results Intracranial stenosis is a significant cause of cerebral emboli, and microembolus detection by TCD sonography were widely used in exploring the mechanisms of ischemic stroke with intracranial stenosis （including the middle cerebral artery stenosis and the vertebral-basilar stenosis）, evaluating the prognosis of acute stroke, evaluating the therapeutic effects, and predicting the recurrent events of stroke. Conclusion Microembolus detection by TCD sonography plays an important role in the cerebral ischemic stroke patients with intracranial stenosis.

Compromised cerebrovascular modulation in chronic anxiety:evidence from cerebral blood flow velocity measured by transcranial Doppler sonography

Objective Cerebral autoregulation （CA） is the mechanism by which constant cerebral blood flow is maintained despite changes in cerebral perfusion pressure. CA can be evaluated by dynamic monitoring of cerebral blood flow velocity （CBFV） with transcranial Doppler sonography （TCD）. The present study aimed to explore CA in chronic anxiety. Methods Subjects with Hamilton anxiety scale scores 〉14 were enrolled and the dynamic changes of CBFV in response to an orthostatic challenge were investigated using TCD. Results In both the anxious and the healthy subjects, the mean CBFV was significantly lower in the upright position than when supine. However, the CBFV changes from supine to upright differed between the anxious and the healthy groups. Anxious subjects showed more pronounced decreases in CBFV with abrupt standing. Conclusion Our results indicate that cerebrovascular modulation is compromised in chronic anxiety; anxious subjects have some insufficiency in maintaining cerebral perfusion after postural change. Given the fact that anxiety and impaired CA are associated with cardiovascular disease, early ascertainment of compromised cerebrovascular modulation using TCD might suggest interventional therapies in the anxious population, and improve the primary prevention of cardiovascular disease.

SELECTION OF ACUPOINTS BY DOPPLER SOUND SPECTROGRAM FOR TREATMENT OF INSUFFICIENT BLOOD SUPPLY OF CEREBRAL BASILAR ARTERY

Acupuncture moxibustion has been recognized to be effective for treatment of cerebral ischemia, but there are still some problems such as undefined criteria for evaluating the effectiveness and unchecked selection of acupoints. In the late 1980s, cerebrovascular examination was revolutionized in China

Evaluation of diagnosis and curative criterion for concussion patients by color three-dimensional trascrani doppler

Objective In order to offer a noninvasive and objective examination method for assessing the clinical diagnosis and eurative criterion of concussion patients,the patients color three－dimensional transcranial doppler(3D－TCD)characteristic at deferent phases,parameter and clincal manifestation were studied.Method Parameter of Median Cerebral Artery(MCA),Base Artery(BA),the average peak forwand velocity of cerebral blood flow,train figure were tested by 3D－TCD within 24 hours,3－6 days and at the end of treatment,respectively.The results were compared with clinical diagnoses and curative criterion.Result Among 135 patients who had clinically diagnosed concussion,agreeable diagnoses 101 cases,basically agreeable diagnoses 12 cases,disagreeable diagnosis 22 cases(16.2％).At the end of treatment, according to clinical determination 96 cases(71.1％)were cured,39 cases(28.9％)were improved.Wave train character,figure and diagnoses parameter of cerebral spasm caused by concussion were suggested.Conclusion To be one of the diagnostic bases and curative criterion,3D－TCD technology is performable.Meanwhile,it is a new testing objective technique for assessing curative and determining prognosis.

Transcranial Doppler for detection of changes in ophthalmic artery blood flow

The ophthalmic artery （OA） is a main branch of the internal carotid artery （ICA）. Severe internal carotidartery stenosis or occlusion may not only affect the blood supply to the brain, but may also cause OA insufficiency, leading to ocular ischemia. Therefore, research on the hemodynamic changes in the OA in patients with ICA stenosis or occlusion has increasingly attracted more ophthalmologists＇ attention.1 Transcranial Doppler （TCD） is simple and noninvasive, has been widely used in the inspection of cerebrovascular disease,

慢性直立不耐受人群血流动力学模式与缺血性卒中发病风险关系的前瞻性研究

目的:探讨慢性直立不耐受(OI)人群血流动力学模式与缺血性卒中发病风险的关联,为早期评估缺血性卒中的发病提供依据。方法:以多阶段随机抽样的方法抽取吉林省长春市3个街道/乡镇≥40岁638名居民作为研究对象,经颅多普勒(TCD)联合直立倾斜试验(HUTT)评估OI人群血流动力学模式,建立OI研究队列;按血流动力学改变模式将患者分为直立位低血压(OH)组、直立位高血压(OHT)组、体位性心动过速综合征(POTS)组和直立性脑低灌注综合征(OCHOs)组;对入选的研究对象每半年随访1次,随访2年;以首次缺血性卒中发病为观察终点,收集研究对象基线资料和随访期间缺血性卒中发病情况,采用Cox比例风险模型分析与缺血性卒中发病风险关联的因素。结果:121例研究对象符合OI诊断标准,其中OH组80例(66.12%),OHT组35例(28.93%),POTS组5例(4.13%),OCHOs组1例(0.82%);随访期间,总体人群确诊新发缺血性脑卒中事件共43例;在控制相关混杂因素后,以非OI者为参照,OI全人群、OH和OHT患者发生缺血性卒中的风险分别增加1.527倍[风险比(HR)=2.527,95%CI:1.269~5.032,P<0.01]、2.268倍(HR=3.268,95%CI:1.603~6.663,P=0.001)和2.153倍(HR=3.153,95%CI:1.213~8.916,P=0.008)。结论:OI与缺血性卒中发病风险增加有关,其中OH组和OHT组患者发病风险增加尤为明显。

基于制定脑血管超声检测若干问题中国专家共识的调查分析

目的调查我国脑血管超声诊断现状、诊断难点以及制定脑血管超声检测若干问题中国专家共识的必要性。方法采用网络问卷调查方式,以各级医疗机构经颅多普勒超声(TCD)和经颅彩色多普勒超声(TCCD)从业人员为调查对象,对脑血管超声检测若干问题中国专家共识的需求情况进行问卷调查。问题条目涉及应答人群的基本情况,包括医疗机构所在区域(Q1)、医疗机构级别(Q2),TCD或TCCD从业人员执业范围(Q3)、职称(Q4);脑血管及颈部血管评估模式(Q5);专家共识总体需求情况(Q6)以及TCD诊断相关问题(Q7~Q17)。TCD诊断相关问题有3个维度(诊断标准、多维度综合评估和血运重建围手术期动态监测),共11个条目(Q7~Q17:颅内动脉狭窄或闭塞、血管发育变异、侧支循环判断、血运重建术后的超声动态监测、脑血管痉挛、对比增强TCD检查等问题)。同时设立了开放性问题:脑血管超声最需要完善的内容(Q18)。问卷的信度分析采用可靠性分析,以Cronbach′sα系数≥0.7为信度良好,效度评价采用因子分析。不同条件下对专家共识各条目需求的比较采用χ^(2)检验,等级资料组间比较采用秩和检验(Kruskal-Wallis H)。结果共收回完整、有效的调查问卷1395份,涉及31个省、自治区、直辖市的TCD或TCCD从业人员(西藏自治区无应答),调查具有一定的代表性。信度分析结果显示,Cronbach′sα系数=0.917(F=132.702,P<0.01)。效度分析结果显示,KMO值=0.930(χ^(2)=8478.844,P<0.01),提取3个因子,其累计贡献率为70.600%。应答人群中以三级甲等医院占比最高[64.2%(896/1395)];职称分布以主治医师占比最高[48.5%(676/1395)],其次是高级职称[37.2%(519/1395)];应答人群中,亟需专家共识者占66.6%(929/1395),需要完善现有标准者占32.7%(456/1395)。医疗机构所在区域、从业人员不同职称及不同评估模式的应答人群对专家共识总体需求的差异均有统计学意义(均P<0.05)。结论调查问卷具有较高的信度和效度。应答人群对脑血管超声检测若干问题中国专家共识的需求具有迫切性,专家共识的出台可能有助于建立规范化、精准化评估体系,从而促进脑血管超声检测的质量控制管理及同质化水平。

脑血管超声检测的临床应用进展评述

脑血管超声包括经颅彩色多普勒超声(TCCD)与经颅多普勒超声(TCD)。TCCD与TCD已分别经过了30、40多年的临床应用历程。脑血管超声在颅内、外动脉特别是颅内动脉病变的早期筛查、诊断、治疗与随访,以及在神经重症功能评估和缺血性卒中、蛛网膜下腔出血、右向左分流、脑血流自动调节、镰状细胞贫血等疾病的检查评估中越来越受到临床医师的重视。作者重点评述了脑血管超声在国内外临床应用中的进展。