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.

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.

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.

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.

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.

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.

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

Persistentvegetativestatus(PVS),lockedinsyndromeandbraindeathpatientsareusuallyconfusedintheclinic.TrascranialDopplerisabletodistinguishthisthreestatusaccordingtothedifferentcerebralbloodflow.ThispaperreportstheresultsoftranscranialDopplerultrasounde...

阴茎动脉Doppler超声分析

目的研究健康成年男性阴茎背动脉(DA)、海绵体动脉(CA)PI、RI及S/D的正常值。方法将257名健康成年男性按年龄分为5组,分别为<30岁组65名,30～39岁组83名,40～49岁组61名,50～59岁组38名,60岁以上组10名。用Logidop!2型数字式Doppler超声血流仪检查双侧阴茎背动脉、双侧海绵体动脉PI、RI及S/D值。结果阴茎疲软状态下,阴茎背动脉、海绵体动脉PI、RI和S/D值个体左右比较无差异,各年龄组也无差异。建议正常参考值分别为:(1)LDA:PI1.43～3.43,RI0.72～0.92,S/D2.68～10.56。(2)RDA:PI1.47～3.47,RI0.73～0.93,S/D3.27～10.09。(3)LCA:PI1.49～3.21,RI0.74～0.90,S/D3.17～9.55。(4)RCA:PI1.93～3.27,RI0.72～0.90,S/D3.22～9.42。结论作为一种筛选手段,Doppler超声血流检测手段,有一定的应用价值。

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.

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,

早期康复训练对急性脑缺血患者的经颅超声Doppler和脑电图的影响

目的:探讨并比较早期康复训练对急性脑缺血周边及损伤侧病灶区的血液动力学和脑电图的影响。方法:脑缺血患者60例,随机分为康复治疗组和对照组,各30例,均予脱水和血液稀释扩容等药物治疗。康复治疗组增加康复治疗,每日2次,每次45min。两组疗程均为1个月。治疗前后检测病灶区血管Vm、PI、脑电图和事件相关诱发电位(P300)。结果:康复治疗组临床疗效总有效率96.7%,对照组76.7%;两组治疗后脑血流量均明显改善,但康复治疗组比对照组改善明显(字2=5.01,P<0.01);康复治疗组脑电地形图改善率95.8%,对照组78.2%(字2=5.35,P<0.05);P300潜伏期康复治疗后缩短明显,经统计学处理差异显著(t=5.46,P<0.01)。结论:早期康复治疗可提高脑缺血患者的脑血流量、改善脑电图和事件相关诱发电位,并有较好的临床治疗效果。

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

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

目的 为评估经右锁骨下动脉插管进行选择性顺行脑灌注 (ASCP)的有效性和安全性 ,作为扩展主动脉外科全身停循环的安全期限的一种手段 ,用多单位神经监测来客观地量化其生理反应。方法 择期主动脉外科病人 2 2例 ,所有病人年龄均小于 6 0岁。术前用经颅多谱勒 (TCD)确证颈动脉和锥基底动脉系统通畅和存在有效的侧枝灌注。通过右锁骨下动脉插管建立体外循环。用TCD测量大脑中动脉的峰血流速度 ,反映ASCP的幅度。同时 ,用双波长近红外线光谱仪持续监测局部脑氧饱和度 (rSO2 )。结果 所有病人恢复顺利。当ASCP流量 <5ml·kg 1·min 1时 ,则监测不到大脑中动脉血流 ,调节最低流量在 15- 2 0ml·kg 1·min 1时 ,则维持rSO2 >50 %。ASCP流量与大脑中动脉的峰血流速度和rSO2 均呈高度相关性 (r =0 86和 0 96 ,P <0 0 1)。结论 神经监测下进行ASCP可能扩展主动脉外科全身停循环的安全期限 。

Is medical management useful in Moyamoya disease?

Moyamoya disease(MMD),characterized by progressive internal carotid artery stenosis and collateral vessel formation,prompts cerebral perfusion complications and is stratified into idiopathic and Moyamoya syndrome subtypes.A multifa-ceted approach toward MMD management addresses cerebral infarctions through revascularization surgery and adjunctive medical therapy,while also navigating risks such as intracranial hemorrhage and cerebral infarction resulting from arte-rial stenosis and fragile collateral vessels.Addressing antithrombotic management reveals a potential role for treatments like antiplatelet agents and anticoagulants,despite the ambiguous contribution of thrombosis to MMD-related infarctions and the critical balance between preventing ischemic events and averting hemo-rrhagic complications.Transcranial doppler has proven useful in thromboembolic detection,despite persisting challenges concerning the efficacy and safety of an-tithrombotic treatments.Furthermore,antihypertensive interventions aim to ma-nage blood pressure meticulously,especially during intracerebral hemorrhage,with recommendations and protocols varying based on the patient’s hypertension status.Additionally,lipid-lowering therapeutic strategies,particularly employing statins,are appraised for their possible beneficial role in MMD management,even as comprehensive data from disease-specific clinical trials remains elusive.Com-prehensive guidelines and protocols to navigate the multifaceted therapeutic ave-nues for MMD,while maintaining a delicate balance between efficacy and safety,warrant further meticulous research and development.This protocol manuscript seeks to elucidate the various aspects and challenges imbued in managing and navigating through the complex landscape of MMD treatment.

Future of neurocritical care:Integrating neurophysics,multimodal monitoring,and machine learning

Multimodal monitoring(MMM)in the intensive care unit(ICU)has become increasingly sophisticated with the integration of neurophysical principles.However,the challenge remains to select and interpret the most appropriate combination of neuromonitoring modalities to optimize patient outcomes.This manuscript reviewed current neuromonitoring tools,focusing on intracranial pressure,cerebral electrical activity,metabolism,and invasive and noninvasive autoregulation moni-toring.In addition,the integration of advanced machine learning and data science tools within the ICU were discussed.Invasive monitoring includes analysis of intracranial pressure waveforms,jugular venous oximetry,monitoring of brain tissue oxygenation,thermal diffusion flowmetry,electrocorticography,depth electroencephalography,and cerebral microdialysis.Noninvasive measures include transcranial Doppler,tympanic membrane displacement,near-infrared spectroscopy,optic nerve sheath diameter,positron emission tomography,and systemic hemodynamic monitoring including heart rate variability analysis.The neurophysical basis and clinical relevance of each method within the ICU setting were examined.Machine learning algorithms have shown promise by helping to analyze and interpret data in real time from continuous MMM tools,helping clinicians make more accurate and timely decisions.These algorithms can integrate diverse data streams to generate predictive models for patient outcomes and optimize treatment strategies.MMM,grounded in neurophysics,offers a more nuanced understanding of cerebral physiology and disease in the ICU.Although each modality has its strengths and limitations,its integrated use,especially in combination with machine learning algorithms,can offer invaluable information for individualized patient care.