Role of transcranial Doppler ultrasonography in stroke

Only 10 years old. Is your stroke hospital using this to objectively evaluate the state of your cranial arteries? Or is it just by guess and by golly take aspirin or warfarin and hope that is enough?

Role of transcranial Doppler ultrasonography in stroke

Sanjukta Sarkar, Sujoy Ghosh, Sandip Kumar Ghosh, and Andrew Collier

Author information ► Article notes ► Copyright and License information ►

This article has been cited by other articles in PMC.

Go to:

Abstract

Transcranial Doppler sonongraphy is a non‐invasive, non‐ionising, inexpensive, portable and safe technique that uses a pulsed Doppler transducer for assessment of intracerebral blood flow. This article deals with the principles and technique of transcranial Doppler sonography. It gives a brief overview of its use in evaluation of intracranial steno‐occlusive disease, subarachnoid haemorrhage, and extracranial diseases (including carotid artery disease and subclavian steal syndrome). The role of transcranial Doppler in detection of microembolic signals and evaluation of right to left shunts is also dealt with. Finally, its use in acute stroke is briefly outlined.

Keywords: stroke, transcranial Doppler ultrasoound

Ultrasound has been used for the evaluation of cerebrovascular disease for over a decade (20 years old now, your doctors use of it?) and has made considerable progress. Transcranial Doppler sonography is a non‐invasive, non‐ionising, inexpensive, portable and safe technique that uses a pulsed Doppler transducer for assessment of intracerebral blood flow.

With the advent of thrombolytic treatment for acute ischaemic stroke, the internist would probably benefit from having a knowledge of transcranial Doppler ultrasound (TCD), which is a useful tool for the detection of occlusion of intracranial vasculature. In addition, success of thrombolytic treatment can also be assessed by TCD.

This review article aims to provide a basic understanding about the use of TCD in clinical practice. A brief outline is provided of the principles and techniques of TCD and its role in acute ischaemic stroke, including abnormalities affecting both intracranial and extracranial parts of vessels supplying the brain. We then explore the role of TCD in the detection of microembolic signals, which help in stratification of risk of recurrence of stroke or transient ischaemic attack (TIA), and its role of in the detection and quantification of right‐to‐left shunts. We also outline the possible role of TCD in subarachnoid haemorrhage and subclavian steal syndrome. Finally, the role of TCD during carotid endarterectomy is discussed (box 1).

Box 1: Use of transcranial Doppler ultrasound

• Detection of site/degree of stenosis/occlusion of cerebral vasculature
• Assessment of recanalisation following occlusion (with/without thrombolytic treatment)
• Assessment of collateral flow in intracranial vasculature in cases of critical carotid artery stenosis (extracranial)
• Detection of microemboli: stratification of risk of recurrence of stroke/TIA
• Detection and quantification of right to left shunts
• Detection of degree of vasospasm following subarachnoid haemorrhage
• Complementary to duplex carotid scan in diagnosis of subclavian steal syndrome
• Intraoperative monitoring of carotid endarterectomy