Extracranial carotid artery occlusive disease is a major cause of ischemic stroke in Caucasians. However, intracranial artery occlusive disease, especially middle cerebral artery (MCA) stenosis is more significant in Asians. The underlying mechanisms of ischemic stroke with intracranial artery occlusive lesions is different from that of extracranial artery it is expected to recognize the pathogenesis and epidemiology of intracranial artery occlusive disease. By digital magnetic resonance angiography (MRA) and transcranial doppler (TCD) instead of traumatic subtract angiography methods for screening diagnosis of intracranial artery stenosis that were developed in recent two decades. In current paper, we summarized the results studied with MRA and TCD in Peking Union Medical College Hospital and Chinese University of Hong Kong with literatures reviews in this field. Two aspects are discussed (1) Methods for diagnosis of intracranial artery stenosis; (2) Epidemiology of intracranial artery stenosis.
Angiography, Digital Subtraction ; Carotid Artery, Internal ; diagnostic imaging ; Carotid Stenosis ; diagnosis ; epidemiology ; Cerebral Arteries ; diagnostic imaging ; China ; epidemiology ; Constriction, Pathologic ; diagnosis ; diagnostic imaging ; Humans ; Infarction, Middle Cerebral Artery ; diagnosis ; diagnostic imaging ; Intracranial Arteriosclerosis ; diagnosis ; epidemiology ; Magnetic Resonance Imaging ; Ultrasonography, Doppler, Transcranial

OBJECTIVETo discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler (TCD) sonography in intracranial stenosis-occlusive disease.

DATA SOURCESAll 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 SELECTIONOriginal articles and reviews were selected if they were related to the clinical utilization of microembolus detection in intracranial stenosis-occlusive disease.

RESULTSIntracranial 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.

CONCLUSIONMicroembolus detection by TCD sonography plays an important role in the cerebral ischemic stroke patients with intracranial stenosis.

Constriction, Pathologic ; diagnostic imaging ; Humans ; Intracranial Embolism ; diagnostic imaging ; Stroke ; diagnostic imaging ; Ultrasonography, Doppler, Transcranial ; methods

OBJECTIVETo investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions (IAOLs), and their correlation with thyroid function.

METHODSWe enrolled 7 patients who had Graves' disease (GD) with IAOLs screened and evidenced by transcranial Doppler, then further confirmed with digital substract angiography in 2 patients and magnetic resonance angiography in 5 patients. Brain magnetic resonance imaging (MRI) was performed in all 7 patients. Three patients were followed up.

RESULTSAmong 7 patients, 1 was male and 6 were females. The mean age was 32.0 +/- 5.5 (range from 11 to 49) years old. Six of them had symptoms of GD but one was asymptomatic with abnormality of T3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the internal carotid artery system in 6 patients, as well as asymmetrical in 1 patient Terminal internal carotid artery (TICA) were involved in all 7 patients. Middle cerebral artery (MCA) were involved in 3, anterior cerebral artery in 2, and basilar artery in 1 patient. Net-like collateral vessels and mimic moyamoya disease were observed in the vicinity of the occlusive arteries in 2 patients. All patients presented symptoms of ischemic stroke including transient ischemic attack and/or infarction while IAOLs were found. Three patients had obvious involuntary movements. Brain MRI revealed infarctions located in the cortex, basal ganglion, or hemiovular center in 5 patients. The remaining 2 patients had normal brain MRI. The neurological symptoms were improved concomitant with relief of the thyroid function in 2 patients, while IAOLs were aggravated with deterioration of the thyroid function in 1 patient.

CONCLUSIONIAOLs in patients with GD mainly involve intracranial arteries, especially the TICA and MCA, which is similar to moyamoya disease. The neurological symptoms and severity of involved arteries may relieve while the hyperthyroidism is gradually under control.

Adolescent ; Adult ; Angiography, Digital Subtraction ; Antithyroid Agents ; therapeutic use ; Brain ; diagnostic imaging ; pathology ; Carotid Artery, Internal ; Carotid Stenosis ; complications ; diagnostic imaging ; drug therapy ; Child ; Female ; Follow-Up Studies ; Graves Disease ; complications ; diagnostic imaging ; drug therapy ; Humans ; Infarction, Middle Cerebral Artery ; complications ; diagnostic imaging ; drug therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ultrasonography, Doppler, Transcranial

At the Department of internal neurology of Cho Ray Hospital from Dec 2000 to Jan 2003. 130 patients with acute hemisphere cerebral ischemic stroke were studied. Among them, 34 patients could not evaluated by transcranial Doppler sonography, only 79 had transcranial Doppler sonography (TDS) results and MRI results, which confirmed cerebral infarctus. TDS found 30 normal cases, 28 cases with asymmetric indices reduced, 18 cases increased, 1 case of localized acceleration, 2 cases of obstructive cerebral artery in the side of clinical symptom. MRI found 17 normal cases, 62 cases of stricture of cerebral arteries. Sensitivity and specificity of TDS accounted for 74.2% and 82.4% in comparing with cerebro-vascularogramme made by MRI.
Cerebrovascular Accident ; Brain Ischemia ; Cerebral Angiography ; Ultrasonography, Doppler, Transcranial

Ultrasound is used in the diagnosis, treatment and follow-up of cerebral arteriovenous malformation (AVM). Several parameters including flow velocity, flow volume, resistance index, pulsatility index, vasomotor reactivity and their influencing factors are reviewed. The applications of ultrasound in the preoperative evaluation, intraoperative monitor and postoperative follow-up of AVM, are summarized. Although some limits exist, ultrasound can provide more reliable information about AVM, if lesions are classified according to their characteristics, compared in different conditions between preoperation and postoperation, feeding and non-feeding side, patients and healthy adults, and if ultrasound method is combined with other examinations and different developed ultrasound techniques. With the appearance and development of new ultrasound technique, its application will be wider in management of AVM.
Humans ; Intracranial Arteriovenous Malformations ; diagnostic imaging ; pathology ; Ultrasonography, Doppler, Transcranial ; methods

OBJECTIVETo study psychiatric features and the manifestations of central nervous system involvement in Chinese patients with primary Sjogren's syndrome (PSS).

METHODSThe Minnesota Multiphasic Personality Inventory (MMPI) was used to study 27 PSS female patients and 57 healthy women. The results from two groups were compared. Ten SS patients were evaluated by electroencephalography (EEG), transcranial doppler ultrasound (TCD) and magnetic resonance imaging (MRI).

RESULTSOf 27 patients tested, the three highest clinical mean scales included Hypochondriasis (Hs), Hysteria (Hy), Psychasthenia (Pt) were found. When PSS group was compared with normal control, T scores of SS patients were significantly higher than the healthy women in Hs, Hy. Abnormal EEG was found in 3 of 9 PSS patients. TCD was abnormal in 5 of 9 patients. MRI in 1 patient showed abnormality.

CONCLUSIONSThis study shows that the personality of PSS patients is abnormal, the features are neuroticism. Central nervous system was markedly involved in Chinese patients with PSS, including abnormal EEG and TCD. The changes of central nervous system may be related to abnormalities of psychiatric changes.

Adult ; Aged ; Electroencephalography ; Female ; Humans ; MMPI ; Magnetic Resonance Imaging ; Middle Aged ; Sjogren's Syndrome ; diagnostic imaging ; physiopathology ; psychology ; Ultrasonography, Doppler, Transcranial

OBJECTIVETo summarize the ultrasonography features of neonate corpus callosum agenesis for better diagnosis of this condition.

METHODSA total of 8563 neonates were screened by cerebral ultrasound in neonate care unit of our hospital from June 2010 to December 2012, and 37 cases of agenesis of the corpus callosum were identified. The diagnostic accuracy of ultrasonography and magnetic resonance imaging (MRI) for this condition was evaluated.

RESULTSThe sensitivity, specificity, and accuracy of ultrasound diagnosis for complete and incomplete absence of neonate corpus callosum were 100% and 90%, 90.9% and 94.1%, 94.6% and 91.9% in the 37 cases, respectively. The Kappa value of ultrasonography and MRI were 0.890 and 0.837, with a consistent rate of 91%.

CONCLUSIONUltrasonography and MRI show a high consistency in the diagnosis of neonatal agenesis of the corpus callosum.

Agenesis of Corpus Callosum ; diagnosis ; diagnostic imaging ; Female ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Retrospective Studies ; Ultrasonography, Doppler, Transcranial

Adolescent ; Adult ; Aged ; Brain Concussion ; diagnostic imaging ; Cerebrovascular Circulation ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Ultrasonography, Doppler, Transcranial

Carotid Artery, Internal ; diagnostic imaging ; Cerebrovascular Disorders ; diagnostic imaging ; physiopathology ; Extremities ; physiopathology ; Humans ; Ischemic Attack, Transient ; complications ; diagnostic imaging ; drug therapy ; Male ; Middle Aged ; Middle Cerebral Artery ; diagnostic imaging ; Thromboembolism ; diagnostic imaging ; physiopathology ; Ultrasonography, Doppler, Transcranial

OBJECTIVETo explore the clinical screening and value of vertebral artery ultrasound, Transcranial doppler (TCD), Magnetic resonance angiography (MRA) and Computed tomography angiography (CTA) in the diagnosis of cerebral arteriosclerosis combined with vertebral artery abnormalies according to vertebral artery digital subtraction angiography (DSA).

METHODSFrom January 2006 to September 2010, 186 patients with cerebral arteriosclerosis were retrospectively analyzed. Among the patients, 133 cases were males and 53 cases were females,ranged from 30 to 84 years (with a mean of 63.8 years). All the patients were estimated by DSA; 172 cases were estimated vertebral artery ultrasound and TCD; 53 cases were estimated by MRA; 25 cases were estimated by CTA. The positive results by DSA were seen as case group, while the negative results were seen as control group. The sensitivity, specificity and concordance rate among four groups were calculated.

RESULTSThe abnormality rate of vertebral artery with DSA, vertebral artery ultrasound, TCD, MRA and CTA separately was 50.00% (93/186), 30.81% (53/172), 49.42% (85/172),15.10% (8/53) and 40.00% (10/25). According to DSA standard, the sensitivity of vertebral artery ultrasound in diagnosing was 50.57%, the specificity was 89.41%, and concordance rate was 69.77%; while the sensitivity of TCD was 68.48%, the specificity was 72.50%, and concordance rate was 70.35%; the sensitivity of MRA was 21.43%, specificity was 92.00%, and concordance rate was 54.72%; the sensitivity of CTA was 63.64%,the specificity was 78.57%, and concordance rate was 72.00%.

CONCLUSIONThe reasonable and combined application of vertebral artery ultrasound, TCD, MRA and CTA is helpful for diagnosing cerebral arteriosclerosis combined with vertebral artery abnormalies. For the patients with cerebrovascular disease, cervical massage technique should be paid highly attention, which may cause vertebral artery injury and other complications.

Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Arteriosclerosis ; diagnosis ; Cerebral Arteries ; diagnostic imaging ; Cerebrovascular Disorders ; diagnosis ; diagnostic imaging ; Female ; Humans ; Intracranial Arteriosclerosis ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Ultrasonography ; Vertebral Artery ; abnormalities ; diagnostic imaging