PURPOSE: To evaluate the cerebral hemodynamic changes during interictal period in patients with epilepsy, we investigated changes in cerebral blood flow velocities by transcranial Doppler sonography (TCD). METHODS: Blood flow velocities and pulsatility indecies were measured in both anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries, internal carotid arteries, and basilar artery using TCD in 21 patients with epilepsy and 21 age and sex matched normal adults. We also evaluated the effects of seizure type, seizure frequency, EEG findings, and anticonvulsant medication on cerebral blood flow velocities. RESULTS: The blood flow velocities of cerebral arteries were decreased in patients, but the pulsatility indecies weren't different. Cerebral blood flow velocities were influenced by seizure type, EEG findings, or anticonvulsant medication. CONCLUSION: Our study demonstrates that cerebral blood flow velocities might be decreased during interictal period in patients with epilepsy, and suggests that TCD is an useful method for the investigation of the cerebral hemodynamic changes in epilepsy.
Adult ; Anterior Cerebral Artery ; Basilar Artery ; Blood Flow Velocity ; Carotid Artery, Internal ; Cerebral Arteries ; Electroencephalography ; Epilepsy* ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Seizures ; Ultrasonography, Doppler, Transcranial

We provide the examination technique and the normal values of the cerebral blood flow velocity assessed with the transcranial doppler ultrasound system (TC2-64B, EME) operating at 2MHz in 50 volunteer adult subjects who had no history of neurological illness. Their age ranged from 20 to 58 years and 30 were men. We examined the middle cerebral artery (MCA), the anterior cerebral artery (ACA), the posterior cerebral artery (PCA), the internal carotid (ICAl the opthalmic artery (OPA), and the basilar artery (BA). For each artery we analyzed peak systolic, peak diastolic. And mean flow velocity. Reference values of mean velocities (cm/sec) were 53.2-58.5 for MCA; 48.7-53.8 for ACA; 30.8-33.2 for PCA; . 38.6-42.5 for ICA;11.7-13.1 for OPA;and 34.2-39.9 for BA (95% confidence interval). The velocities correlated inversely with age (p<0.05) arld were significantly lower in the posterior circulation (PCA and BA) than in anterior circulation (MCA, ACA and ICA). There was no difference between both.sexes and between the right and the left side.
Adult ; Anterior Cerebral Artery ; Arteries ; Basilar Artery ; Blood Flow Velocity* ; Humans ; Male ; Middle Cerebral Artery ; Passive Cutaneous Anaphylaxis ; Posterior Cerebral Artery ; Reference Values ; Ultrasonography* ; Volunteers

BACKGROUND: Transcranial Doppler ultrasonography (TCD) is limited by insufficient ultrasound penetration through the temporal bone. Recent studies have revealed poor temporal bone windows in 5~30% of patients. In about 38% of the patients with poor temporal bone windows, a temporal window was unilaterally absent. The aim of the present study was to compare the mean flow velocities (MFV) of the middle cerebral arteries (MCA) obtained through the ipsilateral temporal bone window with those obtained through the contralateral one using M-mode TCD. METHODS: Eighteen patients (mean age, 28 y; age range, 21~40 y) who had adequate bilateral temporal bone windows were enrolled and 36 MCAs were investigated. The investigators tried to detect the MCA through the ipsilateral and contralateral temporal windows with two 2-MHz probes simultaneously (ipsilateral insonation and contralateral one, respectively). RESULTS: The MCA MFV measured by ipsilateral insonation was 72.58 +/- 9.78 cm/sec and that demonstrated by contralateral insonation was 70.94 +/- 9.79 cm/sec. Even though the differences between MFVs by either side insonation was 2.25~3.94% (0~13.11%) and had significant difference statistically, those were within side-to-side limit of 30% generally considered as abnormal. The mean bitemporal diameter (BTD) was 130.72 +/- 3.75 cm (126~142 cm). We obtained similar waveforms in the reverse direction to those of ipsilateral insonation at 95.33 +/- 5.19 mm of depths (72.97 +/- 4.23% of BTD) during contralateral insonation. CONCLUSIONS: The demonstration of the MCA through the contralateral insonation provides an opportunity to obtain significant mean flow velocities in patients with absent or insufficient temporal bone window unilaterally.
Humans ; Middle Cerebral Artery ; Research Personnel ; Temporal Bone* ; Ultrasonography ; Ultrasonography, Doppler, Transcranial

The authors performed prospectively the transcranial Doppler monitoring of middle cerebral arteries in 37 patients with ruptured cerebral aneurysm. The entry criteria for the study were confined to the patients who had clinical Grades of 1, 2, or 3, and were operated within 4 days after bleeding. There were several sonographic risk factors of developing delayed ischemic deficits; 1) An early steep increase of flow velocity exceeding 120 cm/sec. 2) An increase of maximum flow velocity more than 140 cm/sec. 3) The flow velocity increasing simultaneously with the onset of delayed ischemic deficit in which case preventive treatment was impossible. 4) Prolonged elevation of flow velocity for more than 7 days despite of aggressive treatment. It seemed to be mandatory to start preventive and aggressive treatment for the asymptomatic patients who showed higher flow velocity than 140 cm/sec. Transcranial Doppler sonography has another potential on deciding the timing of surgery.
Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prospective Studies ; Risk Factors ; Ultrasonography ; Ultrasonography, Doppler, Transcranial

BACKGROUND: Doppler velocimetry studies of placental and fetal circulation can provide important information regarding fetal well­being providing an opportunity to improve fetal outcome. The present study was undertaken to evaluate the role of middle cerebral to umbilical artery pulsatility index ratio (MCA/UA PI Ratio) as a predictor of perinatal outcome in hypertensive pregnant patients admitted from January 2009- December 2011 at the De La Salle-University Medical Center
OBJECTIVES: To correlate the neonatal outcomes of hypertensive pregnant women at 28-34 weeks AOG with the middle cerebral artery and umbilical artery pulsalitility index ratio.
STUDY DESIGN: A retrospective cohort was done on records of patients with hypertension who delivered from January 2009 - Decem­ber 2011. Doppler ultrasound results of said patients that were available at the OB-GYN ultrasound section were recorded and the MCA/UA PI Ratio computed. Doppler results were then compared to neonatal outcomes
RESULTS: Results of the study shows that 10 out of the 17 hypertensive patients with decreased MCA/UA PI Ratio developed Intrau­terine growth restriction. 62.5% of those patients who had normal MCA/UA PI Ratio results delivered term, while 87.5% of those who had decreased MCA/UA PI Ratio delivered preterm (P <0.002). However results of the MCA/UA PI ratio has no association on APGAR scores at 1 and 3 minutes.
CONCLUSION: Decreased MCA/UA PI Ratio results have an association on the development of adverse neonatal outcomes in hyper­tensive pregnant women.

 

 

Human ; Male ; Female ; Pregnancy ; Umbilical Arteries ; Middle Cerebral Artery ; Ultrasonography, Prenatal ; Fetus ; Placenta ; Hypertension ; Ultrasonography, Doppler

PURPOSE: This study was designed to evaluate the usefulness of 3T-TOF MR angiography (3T-TOF MRA) compared with transcranial Doppler sonography (TCD) and conventional angiography (CA) in patients with suspected cerebral infarction. MATERIALS AND METHODS: Fifty four patients with clinical symptoms of cerebral infarction were involved in this study, and had undergone 3T-TOF MRA and TCD, with CA in 11 patients. On the basis of divisions of the carotid artery, four groups were designated: group I, both vertebral arteries and basilar artery; group II, segment between 2 cm below bifurcation of common carotid artery and genu portion of internal carotid artery; group III, segment between petrous portion of internal carotid artery and bifurcation of anterior and middle cerebral artery; group IV, from bifurcation of anterior and middle cerebral artery to thier distal branches. Two radiologists retrospectively reviewed the vascular imaging and stenosis in 3T-TOF MRA, TCD, and CA. RESULTS: A total of 432 arteries, 108 in each group, were available. The assessment of vascular imaging quality in 3T-TOF MRA is scored 2.98, 2.96, 2.91, 2.88 in 4 groups, respectively. Agreement among 3TTOF MR angiography, TCD, and CA was high. CONCLUSION: 3T-TOF MR angiography may be useful method for the assessment of stenotic lesions of cranial vasculature in patients with cerebral infarction.
Angiography* ; Arteries ; Basilar Artery ; Carotid Arteries ; Carotid Artery, Common ; Carotid Artery, Internal ; Cerebral Infarction* ; Constriction, Pathologic ; Humans ; Middle Cerebral Artery ; Retrospective Studies ; Ultrasonography, Doppler, Transcranial ; Vertebral Artery

The clinical utility of transcranial doppler ultrasonography (TCD) in cerebrovascular disease has been extended recently. Although number of studies have been performed to define normal reference values of TCD measurements, they have some limitations to be used as reference values which include relatively small number of subjects, lack of data about some cerebral vessels and/or parameters. This study was aimed to obtain clinically useful reference values of TCD measurements with consideration of the influence of age and sex in Korean adults, particularly who are in stroke-prone age group. We measured flow velocities, pulsatility indecies, side-to-side differences and vasomotor reactivities of all intra-and extracranial cerebral arteries using TCD in 209 normal Korean adults (age, 23-78 years; 94 men and 115 women), and analyzed the influence of age and sex on those measurements. With advancing age, subjects showed significant reduction in velocity measurements and increase in pulsatility indecies of most examined arteries. Females showed hight velocities of middle cerebral, internal carotid, vertebral and basilar artery and lower pulsatility indecies of middle cerebral arteries compared with males. Asymmetry measurements including side-to-side differences and asymmetry index, and ,breath holding index testing vasomotor reactivity were also measured and the normal range of those parameters were calculated. Since present study included large number of subjects, and checked paramenters of TCD in both extra- as well as intracranial cerebral arteries, we are convinced that these results can be used as a reference data of TCD measurements in Korean adults.
Adult* ; Arteries ; Basilar Artery ; Breath Holding ; Cerebral Arteries ; Female ; Humans ; Male ; Middle Cerebral Artery ; Reference Values* ; Ultrasonography, Doppler, Transcranial

We report a case of borderzone infarction which was developed after the coil embolization of unruptured internal carotid-posterior communicating artery aneurysm. Post-procedural angiography and brain computerized tomographic scan did not reveal any abnormality. However, brain magnetic resonance image (MRI) showed a wedge-shaped borderzone cerebral infarction between left middle cerebral artery and left anterior cerebral artery territory. It was suspected to be a manifestation of hypoperfusion in the internal carotid artery territory, caused by hemodynamic instability during the procedure. In order to prevent this unexpected serious complication, using the continuous hemodynamic monitoring during aneurysmal coil embolization, such as transcranial doppler ultrasonography, should be considered.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Brain ; Carotid Artery, Internal ; Cerebral Infarction ; Embolization, Therapeutic* ; Hemodynamics* ; Infarction* ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Ultrasonography, Doppler, Transcranial

BACKGROUND: Anterior cerebral artery (ACA) flow abnormalities on a transcranial Doppler ultrasonography (TCD) represent various conditions, which include hyperemic collateral to the ipsilateral middle cerebral artery (iMCA) or contralateral internal carotid artery (cICA) pathology, and ipsilateral anterior cerebral artery (iACA) stenosis. However, studies related to these conditions have rarely been done. We evaluated the hemodynamic significance of ACA flow abnormalities on TCD without angiographic information. METHODS: We analyzed TCD records, which were recruited consecutively during a 10-month period in our laboratory. ACA abnormalities on TCD were defined as follows: 1) mean flow velocities (mFV) of ACA>80 cm/sec; 2) ipsilateral mFV ACA/MCA> 1.2; 3) anterior cerebral artery veloci-ty ratios (ACAVR)> 1.34. We then correlated TCD patterns with a magnetic resonance angiography (MRA) or trans-femoral cerebral angiography (TFCA). RESULTS: Thirty-five patients were recruited to participate in this study. Based on MRA or TFCA, we found 4 patterns of vascular status which could explain the ACA abnormalities on the TCD. The iMCA pathology was demonstrated in 14 cases, cICA pathology in 11 cases, iACA stenosis in 3 cases, and cACA hypoplasia in 5 cases. Eight cases did not show any vascular pathology. CONCLUSIONS: ACA flow abnormalities should be evaluated with absolute flow velocity indicies, as well as other indexes, which mostly signify hyperemic collateral flow to the iMCA or cICA steno-occlusion. (J Korean Neurol Assoc 19(4):349~353, 2001)
Angiography ; Anterior Cerebral Artery* ; Carotid Artery, Internal ; Cerebral Angiography ; Constriction, Pathologic ; Hemodynamics ; Humans ; Magnetic Resonance Angiography ; Middle Cerebral Artery ; Pathology ; Ultrasonography, Doppler, Transcranial*

BACKGROUND: The basilar artery (BA) may act as an important intracranial collateral to supply hypoperfused anterior circulation. We examined the basilar reserve capacity by using transcranial Doppler sonography (TCD) in patients with occlusive vascular diseases in the anterior circulation (OAC) to determine whether vasomotor reactivity (VMR) of the BA can be affected by the presence of OAC. METHODS: Twenty-five patients were given an MRI including an MRA for minor ischemic symptoms, headache, or dizziness and were divided into two groups according to the presence of OAC. The OAC included occlusions of either the internal carotid artery (ICA) or M1 segment of the middle cerebral artery (MCA). The VMR to hypercapnea was calculated by means of the breath-holding index (BHI). We compared the VMR of the BA between those with and without OAC. RESULTS: Patients with OAC (n=8) showed significantly reduced basilar VMR, compared to that of patients without OAC (n=17) (0.57+/-0.49 versus 1.36+/-0.47, P=0.001). The baseline mean flow velocity of BA was also higher in patients with OAC (70.6+/-24.2cm/s) than those without (38.8+/-11.5 cm/s). However, the baseline pulsatility index did not show differences between patients with and without OAC. CONCLUSIONS: Patients with OAC showed decreased VMR of BA, which can be an easily applicable and useful TCD index for assessing the hemodynamic status in patients with OAC.
Basilar Artery* ; Carotid Artery, Internal ; Dizziness ; Headache ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Ultrasonography, Doppler, Transcranial ; Vascular Diseases*