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      Transcranial Doppler in a Hispanic–Mestizo population with neurological diseases: a study of sonographic window and its determinants

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          Abstract

          Between 5% and 37% of patients are not suitable for transtemporal insonation with transcranial Doppler (TCD). This unsuitability is particularly frequent in elderly females and non-Caucasians. We aim to evaluate TCD efficiency in a mixed Hispanic population in Santiago, Chile and to determine whether factors associated with the presence of optimal windows depend exclusively on patient-related elements. Seven hundred forty-nine patients were evaluated with power mode TCD. Optimal temporal windows (TWs) included detection of the middle, anterior, posterior cerebral arteries and terminal carotid. The patient's age and sex, the location of the examination, the time of day, whether the test was conducted on weekends and whether mechanical ventilation was used were recorded. Percentages of optimal windows were calculated. Examinations were deemed ideal if both TWs were optimal. TWs were obtained in 82% of cases. In univariate analyses, male sex ( P < 0.001), an age below 60 years ( P < 0.0001) and mechanical ventilation ( P= 0.04) correlated with ideal TWs. Using logistic regression where dependent variable was a non-ideal window only male sex odds ratio (OR) 2.3 (1.51–3.45) and age below 60 OR 13.8 (7.8–24.6) were statistically significant. Our findings indicate that Hispanic populations have detection rates for TWs similar to Europeans and are affected by patient-related elements.

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          Most cited references21

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          Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries.

          In this report the authors describe a noninvasive transcranial method of determining the flow velocities in the basal cerebral arteries. Placement of the probe of a range-gated ultrasound Doppler instrument in the temporal area just above the zygomatic arch allowed the velocities in the middle cerebral artery (MCA) to be determined from the Doppler signals. The flow velocities in the proximal anterior (ACA) and posterior (PCA) cerebral arteries were also recorded at steady state and during test compression of the common carotid arteries. An investigation of 50 healthy subjects by this transcranial Doppler method revealed that the velocity in the MCA, ACA, and PCA was 62 +/- 12, 51 +/0 12, and 44 +/- 11 cm/sec, respectively. This method is of particular value for the detection of vasospasm following subarachnoid hemorrhage and for evaluating the cerebral circulation in occlusive disease of the carotid and vertebral arteries.
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            Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

            To review the use of transcranial Doppler ultrasonography (TCD) and transcranial color-coded sonography (TCCS) for diagnosis. The authors searched the literature for evidence of 1) if TCD provides useful information in specific clinical settings; 2) if using this information improves clinical decision making, as reflected by improved patient outcomes; and 3) if TCD is preferable to other diagnostic tests in these clinical situations. TCD is of established value in the screening of children aged 2 to 16 years with sickle cell disease for stroke risk (Type A, Class I) and the detection and monitoring of angiographic vasospasm after spontaneous subarachnoid hemorrhage (Type A, Class I to II). TCD and TCCS provide important information and may have value for detection of intracranial steno-occlusive disease (Type B, Class II to III), vasomotor reactivity testing (Type B, Class II to III), detection of cerebral circulatory arrest/brain death (Type A, Class II), monitoring carotid endarterectomy (Type B, Class II to III), monitoring cerebral thrombolysis (Type B, Class II to III), and monitoring coronary artery bypass graft operations (Type B to C, Class II to III). Contrast-enhanced TCD/TCCS can also provide useful information in right-to-left cardiac/extracardiac shunts (Type A, Class II), intracranial occlusive disease (Type B, Class II to IV), and hemorrhagic cerebrovascular disease (Type B, Class II to IV), although other techniques may be preferable in these settings.
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              Thrombolysis in Brain Ischemia (TIBI) Transcranial Doppler Flow Grades Predict Clinical Severity, Early Recovery, and Mortality in Patients Treated With Intravenous Tissue Plasminogen Activator

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                Author and article information

                Journal
                Brain Behav
                Brain Behav
                brb3
                Brain and Behavior
                Blackwell Publishing Inc (Hoboken, NJ, USA )
                2162-3279
                2162-3279
                May 2012
                : 2
                : 3
                : 231-236
                Affiliations
                [1 ]simpleFacultad de Medicina, Cerebrovascular Program, Neurology Service, Department of Internal Medicine, Clínica Alemana de Santiago, Universidad del Desarrollo Santiago, Chile
                [2 ]simpleFacultad de Medicina, Radiology Department, Clínica Alemana de Santiago, Universidad del Desarrollo Santiago, Chile
                [3 ]simpleFacultad de Medicina, Special Care Unit, Clínica Alemana de Santiago, Universidad del Desarrollo Santiago, Chile
                Author notes
                Alejandro M. Brunser, Facultad de Medicina, Cerebrovascular Program, Neurology Service, Department of Internal Medicine, Neurosonology Laboratory, Clínica Alemana de Santiago, Universidad del Desarrollo, Av. Manquehue Norte 1410, 10th Floor, Vitacura 7630000, Santiago, Chile. Tel: 56 2 2101061; Fax: 56 2 2101060; E-mail: abrunser@ 123456alemana.cl , abrunser2002@ 123456yahoo.com
                Article
                10.1002/brb3.46
                3381627
                22741096
                f9a7b625-7ac6-4ac9-be72-88fe0214ff85
                © 2012 The Authors. Published by Wiley Periodicals, Inc.
                History
                : 20 December 2011
                : 19 January 2012
                : 09 February 2012
                Categories
                Original Research

                Neurosciences
                doppler ultrasound,transcranial doppler sonography,temporal bone window
                Neurosciences
                doppler ultrasound, transcranial doppler sonography, temporal bone window

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