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

To establish management protocol for delayed ischemic deficits(DID), the authors designed a prospective study involving patients with aneurysmal subarachnoid hemorrhage, Fisher group 2 or 3, who had been admitted within 72 hours of the first rupture. The study group consisted of 100 consecutive surgical cases who underwent prophylactic hyperdynamic therapy during the period May 1995 to December 1996. The historical control group was a series of 117 patients, treated between January 1993 and April 1995, who did not undergo the same therapy. DID occurred in seven of 51 patients(13.7%) in the study group who underwent surgery within 72 hours of the first rupture, and in ten of 38 patients(26.3%) in the control group who similarly under surgery. Patients who postoperatively showed evidence of DID were managed as follows ; 1) in those developing DID without increased velocity on transcranial Doppler(TCD) study, hypertension was induced ; 2) in those who on TCD study showed increased flow velocity, cerebral angiography was performed ; 3) those with significant arteriographic vasospasm or delayed cerebral circulation, were intra-arterially infused with papaverine. In conclusion, prophylactic hyperdynamic therapy is an effective tool for the prevention of DID, especially following early surgery. TCD study may not effectively detect DID, but is a useful guide to the selection of management modalities. Intra-arterial papaverine infusion is an effective therapy for angiographic vasospasm and the prevention of DID.
Cerebral Angiography ; Humans ; Hypertension ; Intracranial Aneurysm* ; Papaverine ; Prospective Studies* ; Rupture* ; Subarachnoid Hemorrhage ; 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: Microembolic signals (MES) are associated with the pathogenic mechanism of ischemic stroke with large-artery atherosclerotic disease. We examined the relationship between MES on a transcranial Doppler ultrasonography (TCD) and lesion patterns on diffusion-weighted MR imaging (DWI) in acute ischemic strokes associated with atherosclerotic diseases of the middle cerebral artery (MCA) and internal carotid artery (ICA). METHODS: A total of 405 consecutive patients were monitored for MES within 48 hours of symptom onset. Patients with MES and DWI lesions in the territory of the MCA or ICA and corresponding MCA/ICA stenosis or occlusion on MR angiography (MRA) were included. MCA velocities and lesion patterns on DWI were compared. RESULTS: MES were detected in 25 patients (MCA: 13, ICA: 12). The mean number of MES during 30 minutes of monitoring was 14.2+/-17.3 (range: 1-64, MCA: 13.9+/-13.6, ICA: 14.5+/-21.6, p-value=0.098). The mean flow velocity in the ipsilateral MCA in patients with MCA disease was higher than in patients with ICA disease (129.9+/-74.4 cm/s vs 61.1+/-28.2 cm/s, p=0.006). The frequency of multiple lesions on DWI was higher inpatients with ICA disease than in those with MCA disease (46.1% vs 100%, p=0.003). CONCLUSIONS: Multiple lesions on DWI were more frequent in ICA disease with MES than in MCA disease. Artery-to-artery embolism may be a more important stroke mechanism in acute ischemic stroke with ICA disease.
Angiography ; Arteries ; Carotid Artery, Internal ; Carotid Stenosis ; Constriction, Pathologic ; Embolism ; Humans ; Inpatients ; Middle Cerebral Artery ; Stroke ; Ultrasonography, Doppler, Transcranial

BACKGROUND: Transcranial Doppler Ultrasonography (TCD) is a non-invasive and easily applicable method to evaluate cerebral hemodynamics. The objective of this study is to evaluate the diagnostic value of TCD parameters detecting high-grade extracranial carotid stenosis. METHODS: The subjects were 17 patients who showed high-grade carotid stenosis (>75%) or occlusion on cerebral digital subtraction angiography (DSA) and 18 patients whose DSA were normal. TCD parameters were reversed ophthalmic artery flow (OR), reversed anterior cerebral arterial (ACA) flow (AR), increased flow velocity of contralateral ACA (>80cm/sec; CA), decreased flow velocity of ipsilateral MCA (<30cm/sec; IM), absence of ICA flow at siphon(IS), reduced flow acceleration (<280cm/sec2; FA) and pulsatility index (<0.5; PI) of MCA. RESULTS: The sensitivity of each parameter was 23.5% for OR, 47% for AR, 58.8% for CA, 5.9% for IM, 23.5% for IS, 70.6% for FA and 11.8% for PI, while their specificity was 100% in all parameters, except IS, 83.3%. When AR, CA and FA are combined, the sensitivity increased up to 86.7%. CONCLUSIONS: Reduced flow acceleration of MCA and parameters related with collateral flow through the anterior communicating artery were proved to be more sensitive TCD parameters detecting high-grade extracranial carotid stenosis or occulsion than other parameters. Thus patients with abnormal TCD measurements of these parameters may need further evaluation for carotid disease.
Acceleration ; Angiography, Digital Subtraction ; Arteries ; Carotid Arteries ; Carotid Stenosis* ; Cerebral Angiography ; Hemodynamics ; Humans ; Ophthalmic Artery ; Sensitivity and Specificity ; Ultrasonography* ; 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

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

No abstract available.
*Cerebral Angiography ; Cerebral Arteries/*abnormalities ; Female ; Humans ; Intracranial Aneurysm/*radiography

A double gallbladder is a condition that arises during the fetal period due to the abnormal differentiation of presumptive gallbladder cells, which causes two separate gallbladders, each with their own cystic duct. Most cases are diagnosed incidentally during surgery. Detailed preoperative investigations (ultrasound, oral cholecystography, intravenous cholangiography, CT, ERCP and MRCP) are required for an accurate preoperative diagnosis before considering a cholecystectomy to avoid inadvertent damage to the biliary ductal system and to overlook the second gallbladder during surgery. A total cholecystectomy, with removal of both gallbladders, should be the appropriate treatment for a double gallbladder to avoid complications and a reoperation. We report a patient with an accessory gallbladder, originating from right hepatic duct, and also discuss the characeristics of this rare anomaly.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystography ; Cystic Duct ; Diagnosis ; Gallbladder* ; Hepatic Duct, Common* ; Humans ; Reoperation

INTRODUCTIONTranscranial Doppler (TCD) is an established tool for the non-invasive assessment of cerebral blood flow. Since TCD results vary with the skills and experience of the sonographer, it requires validation against contrast angiography. We evaluated the diagnostic accuracy of TCD against computed tomography angiography (CTA) and the feasibility of the latter as an additional screening tool in our acute ischaemic stroke patients.

MATERIALS AND METHODSOur stroke unit manages about 700 patients annually. Acute stroke patients undergo TCD for vascular assessment of major arteries of the circle of Willis. Randomly selected acute stroke patients with significant stenosis on TCD underwent high-resolution cranial CTA with multidetector helical scanner. CTA was performed within 24 hours of TCD and images were interpreted by a neuroradiologist blinded to TCD findings. An independent neurosonologist reevaluated TCD if CTA findings were contradictory. Additional information by either modality was also noted.

RESULTSFifteen patients (12 men, mean age 61 +/- 15years) with cerebral ischaemia and moderate (>50%) stenosis in > or =1 large intracranial arterial segment on routine TCD were evaluated by CTA. Compared with 21 segments of significant stenosis on CTA, TCD showed 16 true-positive, 3 false-positive and 5 false-negative results (sensitivity: 76.2%, positive predictive value: 84.2%). In 3 cases, TCD showed findings complementary to CTA (real-time embolisation, collateral flow patterns, evidence of distal M2 branch occlusion).

CONCLUSIONTCD in our neurovascular laboratory shows a satisfactory agreement with cranial CTA in evaluating patients with cerebral ischaemia. TCD can provide additional real-time dynamic findings complementary to information provided by CTA.

Aged ; Brain Ischemia ; diagnosis ; Cerebral Angiography ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Singapore ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Transcranial