Objective:To investigate the diagnostic value of transcranial Doppler ultrasound(TCD)in elderly patients with cerebrovascular disease and emotional disorder.Methods:Sixty-seven patients with cerebrovascular disease ag...Objective:To investigate the diagnostic value of transcranial Doppler ultrasound(TCD)in elderly patients with cerebrovascular disease and emotional disorder.Methods:Sixty-seven patients with cerebrovascular disease aged 60 years or above and with white matter hyperintensity(WMH)on magnetic resonance imaging(MRI)were enrolled in the study.The patients were divided into two groups according to Hamilton Depression Scale(HAMD)score:vascular depression group(WMH with depression)and non-depressive group(WMH without depression).TCD was performed in both groups,and the results of vascular pulsatility index(PI)and average blood flow velocity(Vm)were compared.Results:A total of 67 elderly patients were enrolled,with 33 cases in the vascular depression group and 34 in the non-depression group according to HAMD scores.(1)No statistically significant differences were observed between the two groups in age,gender,smoking history,alcohol consumption history,hypertension history,diabetes history,ischemic stroke history,hemorrhagic stroke history,coronary heart disease history,white matter score,and white matter grading(P>0.05).(2)The Vm on both sides of the anterior cerebral artery(ACA)and middle cerebral artery(MCA)in the vascular depression group was significantly lower than that in the non-depressive group(P<0.05).However,no statistically significant difference was found in Vm on both sides of the terminal internal carotid artery(TICA)between the two groups(P>0.05).(3)The PI on both sides of the ACA and MCA in the vascular depressive group was significantly higher than that in the non-depression group(P<0.05),while no statistically significant difference was observed in TICA PI values(P>0.05).(4)No statistically significant differences were found in Vm and PI values of the left ACA and MCA compared to the right side in the vascular depression group(P>0.05).Conclusion:The hemodynamic disturbance of vascular depression can be manifested as increased resistance and slowed flow velocity of intracranial small arteries.Transcranial Doppler ultrasound is a valuable method for dynamic evaluation and auxiliary diagnosis of vascular depression.展开更多
Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiograp...Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.展开更多
Objective Cerebral autoregulation(CA)is the mechanism by which constant cerebral blood flow is maintained despite changes in cerebral perfusion pressure.CA can be evaluated by dynamic monitoring of cerebral blood flow...Objective Cerebral autoregulation(CA)is the mechanism by which constant cerebral blood flow is maintained despite changes in cerebral perfusion pressure.CA can be evaluated by dynamic monitoring of cerebral blood flow velocity(CBFV)with transcranial Doppler sonography(TCD).The present study aimed to explore CA in chronic anxiety.Methods Subjects with Hamilton anxiety scale scores〉14 were enrolled and the dynamic changes of CBFV in response to an orthostatic challenge were investigated using TCD.Results In both the anxious and the healthy subjects,the mean CBFV was significantly lower in the upright position than when supine.However,the CBFV changes from supine to upright differed between the anxious and the healthy groups.Anxious subjects showed more pronounced decreases in CBFV with abrupt standing.Conclusion Our results indicate that cerebrovascular modulation is compromised in chronic anxiety;anxious subjects have some insufficiency in maintaining cerebral perfusion after postural change.Given the fact that anxiety and impaired CA are associated with cardiovascular disease,early ascertainment of compromised cerebrovascular modulation using TCD might suggest interventional therapies in the anxious population,and improve the primary prevention of cardiovascular disease.展开更多
BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using co...BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using contrast-enhanced transcranial Doppler(c-TCD)are numerous.According to the time phase and number of microbubbles detected on c-TCD,RLS can be classified and graded.We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIM To explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODS We retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital.In total,111 PFO-related CS patients were divided according to whether RLS was permanent(microbubbles detected both at resting state and after the Valsalva maneuver)or latent(microbubbles detected only after the Valsalva maneuver)on c-TCD.Each group was subdivided into small,mild and large RLS according to the grade of shunt on c-TCD.A normal control group was composed of 33 patients who suffered from simple dizziness.Intragroup and intergroup differences were analyzed in terms of clinical,laboratory and diffusion-weighted imaging lesion characteristics.The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTS In 111 patients with PFO-related CS,68 had permanent RLS and 43 had latent RLS.Clinical characteristics and laboratory tests were not significantly different among the permanent RLS,latent RLS and normal control groups.The proportion of patients with multiple territory lesions in the permanent RLS group(50%)was larger than that in the latent RLS group(27.91%;P=0.021).Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group(30.23%vs 8.82%,P=0.004).Permanent-large and latent-large RLS were both more likely to be related to multiple(P_(trend)=0.017 and 0.009,respectively),small(P_(trend)=0.035 and 0.006,respectively)and cortical(P_(trend)=0.031 and 0.033,respectively)lesions.The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography(r=0.758,P<0.001).CONCLUSION Distribution of the infarct suggested the possible type of RLS.Multiple,small and cortical infarcts suggest large RLS induced by a large PFO.展开更多
BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated in cryptogenic stroke and migraine,with larger shunts posing a higher risk.When used individually to detect RLS,contrast tra...BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated in cryptogenic stroke and migraine,with larger shunts posing a higher risk.When used individually to detect RLS,contrast transcranial Doppler(cTCD)and contrast transthoracic echocardiography(cTTE)may yield false-negative results.Further,the literature exposes gaps regarding the understanding of the limitations of cTCD and cTTE,presents conflicting recommendations on their exclusive use,and highlights inefficiencies associated with nonsynchronous testing.AIM To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.METHODS We prospectively enrolled four patients with cryptogenic stroke(n=1),migraine(n=2),and unexplained dizziness(n=1)who underwent synchronized cTCD combined with cTTE.The participants were monitored and followed-up for 24 months.RESULTS cTTE identified moderate and large RLSs in patients with recurrent cryptogenic stroke and migraines,whereas cTCD revealed only small RLSs.Moderate and large RLS were confirmed on combined cTTE and cTCD.After excluding other causes,both patients underwent PFO occlusion.At 21-and 24-month follow-up examinations,neither stroke nor migraine had recurred.cTTE revealed a small RLS in a third patient with unexplained dizziness and a fourth patient with migraines;however,simultaneous cTCD detected a large RLS.These patients did not undergo interventional occlusion,and dizziness and headache recurred at the 17-and 24-month follow-up examin-ations.CONCLUSION Using cTTE or cTCD may underestimate RLS,impairing risk assessments.Combining synchronized cTCD with cTTE could enhance testing accuracy and support better diagnostic and therapeutic decisions.展开更多
BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to p...BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.展开更多
BACKGROUND： It has been proved that brain electrical activity mapping （BEAM） and transcranial Doppler （TCD） detection can reflect the function of brain cell and its diseased degree of infant patients with moderat...BACKGROUND： It has been proved that brain electrical activity mapping （BEAM） and transcranial Doppler （TCD） detection can reflect the function of brain cell and its diseased degree of infant patients with moderate to severe hypoxic-ischemic encephalopathy （HIE）. OBJECTIVE： To observe the abnormal results of HIE at different degrees detected with BEAM and TCD in infant patients, and compare the detection results at the same time point between BEAM, TCD and computer tomography （CT） examinations. DESIGN ： Contrast observation SETTING： Departments of Neuro-electrophysiology and Pediatrics, Second Affiliated Hospital of Qiqihar Medical College. PARTICIPANTS： Totally 416 infant patients with HIE who received treatment in the Department of Newborn Infants, Second Affiliated Hospital of Qiqihar Medical College during January 2001 and December 2005. The infant patients, 278 male and 138 female, were at embryonic 37 to 42 weeks and weighing 2.0 to 4.1 kg, and they were diagnosed with CT and met the diagnostic criteria of HIE of newborn infants compiled by Department of Neonatology, Pediatric Academy, Chinese Medical Association. According to diagnostic criteria, 130 patients were mild abnormal, 196 moderate abnormal and 90 severe abnormal. The relatives of all the infant patients were informed of the experiment. METHOOS： BEAM and TCD examinations were performed in the involved 416 infant patients with HIE at different degrees with DYD2000 16-channel BEAM instrument and EME-2000 ultrasonograph before preliminary diagnosis treatment （within 1 month after birth） and 1,3,6,12 and 24 months after birth, and detected results were compared between BEAM, TCD and CT examinations. MAIN OUTCOME MEASURES： Comparison of detection results of HIE at different time points in infant patients between BEAM. TCD and CT examinations. RESULTS： All the 416 infant patients with HIE participated in the result analysis. （1） Comparison of the detected results in infant patients with mild HIE at different time points after birth between BEAM, TCD and CT examinations： BEAM examination showed that the recovery was delayed, and the abnormal rate of BEAM examination was significantly higher than that of CT examination 1 and 3 months after birth [55.4%（72/130）vs. 17.0% （22/130 ）,x^2=41.66 ;29.2% （ 38/130 ） vs. 6.2% （ 8/130 ）, x^2=23.77, P 〈 0.01 ], exceptional patients had mild abnormality and reached the normal level in about 6 months. TCD examination showed that the disease condition significantly improved and infant patients with HIE basically recovered 1 or 2 months after birth, while CT examination showed that infant patients recovered 3 or 4 months after birth. （2） Comparison of detection results of infant patients with moderate HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination 1,3,6 and 12 months after birth [90.8% （178/196）,78.6% （154/196）,x^2=4.32,P 〈 0.05;64.3% （126/196）,43.9% （86/196） ,x^2=16.44 ;44.9% （88/196） ,22.4% （44/196）,x^2=22.11 ;21.4% （42/196）, 10.2% （20/196）,x^2=9.27, P 〈 0.01]. BEAM examination showed that there was still one patient who did not completely recovered in the 24^th month due to the relatives of infant patients did not combine the treatment,. TCD examination showed that the abnormal rate was 23.1%（30/196）in the 1^st month after birth, and all the patients recovered to the normal in the 3^rd month after birth, while CT examination showed that mild abnormality still existed in the 24^th month after birth （1.0% ,2/196）. （3） Comparison of detection results of infant patients with severe HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination in the 1^st, 3^rd, 6^th and 12^th months after birth[86.7% （78/90）,44.4% （40/90）,x^2=35.53;62.2% （56/90）,31.1% （28/90）,x^2=17.51 ;37.8% （34/90）,6.7% （6/90）, x^2=27.14, P 〈 0.01]. BEAM examination showed that mild abnormality still existed in 4 infant patients in the 24^th month after birth. TCD examination showed that the abnormal rate was 11.1% （10/90） in the 3^rd month after birth, and all the infant patients recovered in the 6^th month after birth. CT examination showed that the abnormal rate was 6.7%（6/90） in the 12^th month after birth, and all of infant patients recovered to the normal in the 24^th month after birth.CONCLUSION ： BEAM is the direct index to detect brain function of infant patients with HIE, and positive reaction is still very sensitive in the tracking detection of convalescent period. The positive rate of morphological reaction in CT examination is superior to that in TCD examination, and the positive rate is very high in the acute period of HIE in examination.展开更多
Objective:For patients with early acute cerebral infarction(ACI),transcranial Doppler ultrasound was used in the clinical examination,and its application effect was observed and analyzed.Methods:This study was carried...Objective:For patients with early acute cerebral infarction(ACI),transcranial Doppler ultrasound was used in the clinical examination,and its application effect was observed and analyzed.Methods:This study was carried out between October 2018 and October 2019.50 patients with ACI included as the research object was evaluated by transcranial Doppler and CT examination,and the application of the two examination methods was compared.Results:The results of transcranial Doppler examination showed that the abnormal rate of blood flow velocity and the ratio of both sides(VACA)in patients with early ACI was higher than that of CT examination.Conclusion:With the impact on the location and area of vascular occlusion in patients,VACA can effectively reflect the status and effectiveness of the collateral circulation function of the patient’s pia vessels during cerebral infarction.展开更多
Aim. Comparison of the trascranial Doppler (TCD) characteristics of cerebral circulation in persistent vegetative status (PVS), locked in syndrome and brain death patients. Methods. Using ...Aim. Comparison of the trascranial Doppler (TCD) characteristics of cerebral circulation in persistent vegetative status (PVS), locked in syndrome and brain death patients. Methods. Using TCD ultrasound to detect the flow velocity and waveform patterns of middle cerebral artery (MCA) and basilar artery (BA) in patients with PVS, locked in syndrome and brain death. Results. The mean velocities of middle cerebral artery (Vmca) and basilar artery (Vba) were 30.0cm/s and 24.3cm/s in PVS patients respectively, which decreased 45.0% and 14.4% in comparing with normal value. For patients with locked in syndrome, Vmca and Vba were 49.7cm/s and 9.8cm/s, which decreased 5.0% and 61.7% than the normal value respectively. These results showed that the decrease of anterior circulation was predominant in PVS, and the decrease of posterior circulation was predominant in locked in syndrome. A unique diastolic reverse flow, short peak systolic wave or undetectable flow signal in middle cerebral artery were predominant in brain death patients, which was completely different from that of either PVS or locked in syndrome. Conclusion. TCD was a valuable tool in distinguishing PVS, locked in syndrome and brain death patients according to the differences in velocities and patterns of anterior and posterior cerebral arteries.展开更多
BACKGROUND： Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide （NO） in vivo. OBJECTIVE： To study the therapeutic effects of N...BACKGROUND： Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide （NO） in vivo. OBJECTIVE： To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency （VBI） through transcranial Doppler （TCD） detection and serum NO content and indirect effect of TCD on cerebral blood flow changes. DESIGN： Randomized grouping and controlled clinical study. SETTING： Department of Neurology, the Fourth People＇s Hospital of Jinan. PARTICIPANTS： A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People＇s Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confumed consent. They were randomly divided into low-dose treatment group （n =60）, high-lose treatment group （n =30） and control group （n =40）. METHODS： Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition, ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment. According to the TCD test, VBI patients were divided into two groups （high-low flow velocity）. The vertebral artery （VA） and basal artery （BA） of left or right sides were detected by 2 Hz detector via occipital window. MAIN OUTCOME MEASURES： ①Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD before treatment, after treatment for one course; ②content of serum NO indirectly measured by using nitric acid disoxidation technique. RESULTS： All 130 VBI patients were involved in the final analysis. ①Changes of hemodynamic indexes： Systolic phase of VA and diastole phase of BA were higher in low-dose treatment group than that in the control group after first treatment, and there was significant difference （P 〈 0.05）; meanwhile, systolic phase and diastole phase of VA and systolic phase of BA were also higher in treatment group than that in the control group after one course （P 〈 0.05）. However, both systolic phase and diastole phase of VA and BA were lower in high-dose treatment group than that in the control group after first treatment and one course, and there was significant difference （P 〈 0.05）. ②Content of serum NO： After first treatment, there was no significant difference between low-dose treatment group and high-dose treatment group （P 〉 0.05）; but both groups were higher than control group, and there was significant difference （P 〈 0.05, 0.01）. CONCLUSION： NO vector of ultrasonic atomizing inhalation can improve VBI so as to improve cerebral blood-supply state.展开更多
Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neu...Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses Methods In twenty two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD) During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO 2) using dual wavelength spatially resolved near infrared spectroscopy Results All patients experienced an uneventful recovery Flow in the middle cerebral artery became undetectable at ASCP < 5?ml·kg 1 ·min 1 , so adjustments from a 15-20?ml·kg 1 ·min 1 baseline were used to maintain rSO 2 above 50% Furthermore, ASCP flow was highly correlated ( P <0 01) with both peak middle cerebral artery velocity and rSO 2 ( r =0 86 and 0 96, respectively) Conclusion Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort展开更多
Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler （TCD） sonography in intracranial stenosis-occlusive disease. Data sources All related articles in th...Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler （TCD） sonography in intracranial stenosis-occlusive disease. Data sources All 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 selection Original articles and reviews were selected if they were related to the clinical utilization of microembolus detection in intracranial stenosis-occlusive disease. Results Intracranial 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. Conclusion Microembolus detection by TCD sonography plays an important role in the cerebral ischemic stroke patients with intracranial stenosis.展开更多
The ophthalmic artery （OA） is a main branch of the internal carotid artery （ICA）. Severe internal carotidartery stenosis or occlusion may not only affect the blood supply to the brain, but may also cause OA insuff...The ophthalmic artery （OA） is a main branch of the internal carotid artery （ICA）. Severe internal carotidartery stenosis or occlusion may not only affect the blood supply to the brain, but may also cause OA insufficiency, leading to ocular ischemia. Therefore, research on the hemodynamic changes in the OA in patients with ICA stenosis or occlusion has increasingly attracted more ophthalmologists＇ attention.1 Transcranial Doppler （TCD） is simple and noninvasive, has been widely used in the inspection of cerebrovascular disease,展开更多
Acupuncture moxibustion has been recognized to be effective for treatment of cerebral ischemia, but there are still some problems such as undefined criteria for evaluating the effectiveness and unchecked selection of ...Acupuncture moxibustion has been recognized to be effective for treatment of cerebral ischemia, but there are still some problems such as undefined criteria for evaluating the effectiveness and unchecked selection of acupoints. In the late 1980s, cerebrovascular examination was revolutionized in China展开更多
Cardio-cerebral coupling(CCC)refers to the dynamic interplay between cardiac function and cerebral blood flow,essential for maintaining hemodynamic stability.Disruptions in CCC are particularly relevant in critical ca...Cardio-cerebral coupling(CCC)refers to the dynamic interplay between cardiac function and cerebral blood flow,essential for maintaining hemodynamic stability.Disruptions in CCC are particularly relevant in critical care,where they can exacerbate primary and secondary brain injuries.Ultrasound-based techniques,including transcranial Doppler,transcranial color-coded Doppler,and echocardiography,provide non-invasive methods to assess this relationship at the bedside.This scoping review explores the pathophysiology of CCC,ultrasound methodologies for its evaluation,and its clinical relevance.Key mechanisms such as cerebral autoregulation and neurovascular coupling are discussed,along with ultrasound-derived parameters like pulsatility index,resistance index,and cerebral perfusion pressure.While ultrasound is a valuable tool,its limitations include operator dependency and equipment variability.Emerging evidence suggests that ultrasound-guided protocols,including ultrasound-guided cardio-cerebral resuscitation protocol and ultrasound-guided brain injury treatment protocol,may improve resuscitation strategies and neurocritical care monitoring.Despite its potential,further research is necessary to standardize assessment methods and integrate ultrasound-based CCC evaluation into routine clinical practice.Ongoing multicenter studies are expected to provide robust evidence supporting its clinical utility in managing brain-injured patients.展开更多
Management of intracranial hypertension(IH)has improved in the last decades driven by advancements in monitoring technologies and a deeper understanding of its pathophysiology.Although intracranial pressure(ICP)cathet...Management of intracranial hypertension(IH)has improved in the last decades driven by advancements in monitoring technologies and a deeper understanding of its pathophysiology.Although intracranial pressure(ICP)catheters are still recommended by current guidelines for monitoring patients at risk of IH,these methods are not without limitations.Challenges include procedural complications,availability of these devices in many healthcare settings and technical issues.In this context,management in the absence of ICP monitoring is common and now it can be augmented by intensivist-led point-of-care ultrasound,which includes tools such as transcranial doppler,optic nerve sheath measurement and brain ultrasound.These methods offer anatomic information that can sometimes withhold repeated head computed tomography(CT)scans,but they are also a window into ICP dynamics without the associated risks of invasive monitoring and are reasonable alternatives for guiding treatment,provided an integration between neurological examination,head CT anatomical findings and noninvasive monitors is considered.This manuscript synthesizes the evidence for using invasive ICP monitoring and methods for non-invasive monitoring,more focused on the role of ultrasound,given its wider availability.We also propose a practical approach of how to integrate this information at bedside to avoid both under and overtreatment,by embracing a clinical epidemiology paradigm to guide management decisions.展开更多
Objective To explore the therapeutic efficacy and mechanism of acupuncture at Lieque （列缺 LU 7） in treatment of cervical vertigo （CV）. Methods Forty CV patients met the inclusion criteria were enrolled and treate...Objective To explore the therapeutic efficacy and mechanism of acupuncture at Lieque （列缺 LU 7） in treatment of cervical vertigo （CV）. Methods Forty CV patients met the inclusion criteria were enrolled and treated with acupuncture at bilateral LU 7 points, once daily with 10 times as a course. The changes of blood flow velocity in bilateral vertebral artery and basilar artery were observed through transcranial doppler sonography （TCD） before treatment, after deqi with acupuncture and after a course of treatment, respectively. The scores and therapeutic efficacy on clinical symptoms were assessed according to CV symptoms and the functional assessment scale as well as the Criteria-for Diagnosis and Curative Effect in TCM Syndromes before treatment and after a course of treatment. Results Before treatment, after deqi and after a course of treatment, the blood flow velocity of basilar artery （BA）, left vertebral artery （LVA） and right vertebral artery （RVA） in 22 patients with a decreased blood flow velocity were respectively 23.20±4.84 vs 26.30 ± 4.17 vs 29.20 ± 4.20 （mm/s, BA）, 21.65 ± 3.62 vs 24.20 ± 2.89 vs 26.40 ± 3.62 （mm/s, LVA） and 21.90±3.04 vs 24.25±3.01 vs 26.50_±3.95 （mm/s, RVA）, while in 18 patients with an increased blood flow velocity were respectively 39.94 ± 8.24 vs 35.17 ± 4.84 vs 32.06 ± 3.49 （mm/s, BA）, 41.83 ± 5.64 vs 37.28 ± 2.32 vs 35.61 ± 2.09 （mm/s, LVA） and 37.11 ± 9.83 vs 32.22 ± 6.13 vs 28.11 ± 4.12 （mm/s, RVA）. Except that the difference of blood flow velocity of RVA was not significant in patients with an increased blood flow velocity before treatment and after deqi （P 〉 0.05）, the Vm of all vessels in 40 patients was improved after deqi with acupuncture and a course of treatment （P〈0.01, P〈0.05）. According to CV symptoms and the functional assessment scale, before treatment and after a course of treatment, the scores were 15.68 ± 5.35 and 26.30 ± 3.76, respectively, indicating that after a course of treatment, the symptoms were significantly improved （P 〈 0.01）. According to the Criteria for Diagnosis and Curative E.f]ect in TCM Syndromes, after a course of treatment, the total effective rate was 100% （40/40） and the cured rate was 55.0% （22/40）. Conclusion Acupuncture at LU 7 not only improves the blood supply of vertebral-basilar artery in CV patients, but also has a significant curative effect on improving the clinical symptoms.展开更多
Objective To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin. Methods Sixty-eight patients who had ischemic strok...Objective To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin. Methods Sixty-eight patients who had ischemic stroke during the recent 1-6 months were recruited and randomized into cilostazol or aspirin group. Cerebrovascular condition was assessed by magnetic resonance angiography （MRA） and transcranial doppler ultrasonography （TCD） at the beginning of the study and after 12-month medication. Results During the clinical follow-up, ischemic stroke recurred in 2 patients in cilostazol group, while in aspirin group, one case of ischemic stroke recurrence and one case of acute myocardial infarction were found. MRA revealed that in aspirin group, the percentages of patients experiencing aggravation and attenuation of cerebrovascular condition were 3.3% and 6.7%, respectively, while in aspirin group, they were 3.3% and 10%, respectively. Moreover, TCD revealed that 26.9% of the patients in aspirin group and 14.3% of the patients in cilostazol group experienced aggravation of cerebrovascular condition. However, the systolic peak flow velocity of the previously abnormal arteries increased by 42.9% after 12-month medication of cilostazol, which was significantly higher than that after aspirin medication （27.5%） （P = 0.04）. Furthermore, as a major side effect of antiplatelet therapy, the frequrency of bleeding was much less in cilostazol group （0 case in cilostazol group vs 5 in aspirin, P 〈 0.05）. Conclusion Cilostazol is as effective as aspirin in preventing the aggravation of cerebral arteries in secondary prevention of ischemic stroke. Besides, it is more safe. Cilostazol can increase the systolic peak flow velocity of cerebral arteries, which may improve the blood supply of focal ischemia.展开更多
Objective To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions （IA- OLs）, and their correlation with thyroid function. Methods We enrolled 7 patients who had Graves...Objective To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions （IA- OLs）, and their correlation with thyroid function. Methods We 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. Results Among 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 I3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the intemal 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 IA- OLs 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. Conclusion IAOLs 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.展开更多
The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity （BaPWV） and ankle-bra- chial index （ABI） are known to be associated with ischemic cardiovascular a...The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity （BaPWV） and ankle-bra- chial index （ABI） are known to be associated with ischemic cardiovascular and cerebrovascular diseases, whether these measures predict the risk of ischemic cerebrovascular disease in diabetic patients remains unclear. 117 patients with type 2 diabetes were enrolled in this study. According to the results of head magnetic resonance imaging, the patients were divided into a diabetes-only group （n = 55） and a diabetes and ischemic stroke group （n = 62）. We then performed ABI and BaPWV examinations for all patients. Compared with the diabe- tes-only group, we found decreased ABI and increased BaPWV in the diabetes and ischemic stroke group. Multivariate logistic regression analyses revealed that BaPWV and ABI were risk factors for ischemic stroke in patients with type 2 diabetes. Our findings indicate that decreased ABI and increased BaPWV are objective indicators of increased risk of ischemic stroke in patients with type 2 diabetes.展开更多
文摘Objective:To investigate the diagnostic value of transcranial Doppler ultrasound(TCD)in elderly patients with cerebrovascular disease and emotional disorder.Methods:Sixty-seven patients with cerebrovascular disease aged 60 years or above and with white matter hyperintensity(WMH)on magnetic resonance imaging(MRI)were enrolled in the study.The patients were divided into two groups according to Hamilton Depression Scale(HAMD)score:vascular depression group(WMH with depression)and non-depressive group(WMH without depression).TCD was performed in both groups,and the results of vascular pulsatility index(PI)and average blood flow velocity(Vm)were compared.Results:A total of 67 elderly patients were enrolled,with 33 cases in the vascular depression group and 34 in the non-depression group according to HAMD scores.(1)No statistically significant differences were observed between the two groups in age,gender,smoking history,alcohol consumption history,hypertension history,diabetes history,ischemic stroke history,hemorrhagic stroke history,coronary heart disease history,white matter score,and white matter grading(P>0.05).(2)The Vm on both sides of the anterior cerebral artery(ACA)and middle cerebral artery(MCA)in the vascular depression group was significantly lower than that in the non-depressive group(P<0.05).However,no statistically significant difference was found in Vm on both sides of the terminal internal carotid artery(TICA)between the two groups(P>0.05).(3)The PI on both sides of the ACA and MCA in the vascular depressive group was significantly higher than that in the non-depression group(P<0.05),while no statistically significant difference was observed in TICA PI values(P>0.05).(4)No statistically significant differences were found in Vm and PI values of the left ACA and MCA compared to the right side in the vascular depression group(P>0.05).Conclusion:The hemodynamic disturbance of vascular depression can be manifested as increased resistance and slowed flow velocity of intracranial small arteries.Transcranial Doppler ultrasound is a valuable method for dynamic evaluation and auxiliary diagnosis of vascular depression.
文摘Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.
基金supported by grants from China Scholarship Council
文摘Objective Cerebral autoregulation(CA)is the mechanism by which constant cerebral blood flow is maintained despite changes in cerebral perfusion pressure.CA can be evaluated by dynamic monitoring of cerebral blood flow velocity(CBFV)with transcranial Doppler sonography(TCD).The present study aimed to explore CA in chronic anxiety.Methods Subjects with Hamilton anxiety scale scores〉14 were enrolled and the dynamic changes of CBFV in response to an orthostatic challenge were investigated using TCD.Results In both the anxious and the healthy subjects,the mean CBFV was significantly lower in the upright position than when supine.However,the CBFV changes from supine to upright differed between the anxious and the healthy groups.Anxious subjects showed more pronounced decreases in CBFV with abrupt standing.Conclusion Our results indicate that cerebrovascular modulation is compromised in chronic anxiety;anxious subjects have some insufficiency in maintaining cerebral perfusion after postural change.Given the fact that anxiety and impaired CA are associated with cardiovascular disease,early ascertainment of compromised cerebrovascular modulation using TCD might suggest interventional therapies in the anxious population,and improve the primary prevention of cardiovascular disease.
基金People’s Livelihood Science and Technology Project(Research on Application of Key Technologies)of Suzhou(No.SS202061)Technical Cooperation Project of Soochow University(No.H211064).
文摘BACKGROUND Cardiogenic embolism caused by patent foramen ovale(PFO)is a common etiology of cryptogenic stroke(CS),particularly in young and middle-aged patients.Studies about right-to-left shunt(RLS)detection using contrast-enhanced transcranial Doppler(c-TCD)are numerous.According to the time phase and number of microbubbles detected on c-TCD,RLS can be classified and graded.We hypothesized that the characteristics of an infarction lesion on diffusion-weighted imaging differs when combining the type and grade of RLS on c-TCD in patients with PFO-related CS.AIM To explore the characteristics of infarction lesions on diffusion-weighted imaging when combining the RLS type and grade determined by c-TCD.METHODS We retrospectively evaluated CS patients from August 2015 to December 2019 at a tertiary hospital.In total,111 PFO-related CS patients were divided according to whether RLS was permanent(microbubbles detected both at resting state and after the Valsalva maneuver)or latent(microbubbles detected only after the Valsalva maneuver)on c-TCD.Each group was subdivided into small,mild and large RLS according to the grade of shunt on c-TCD.A normal control group was composed of 33 patients who suffered from simple dizziness.Intragroup and intergroup differences were analyzed in terms of clinical,laboratory and diffusion-weighted imaging lesion characteristics.The correlation between RLS grade evaluated by c-TCD and size of PFO determined by transesophageal echocardiography were also analyzed.RESULTS In 111 patients with PFO-related CS,68 had permanent RLS and 43 had latent RLS.Clinical characteristics and laboratory tests were not significantly different among the permanent RLS,latent RLS and normal control groups.The proportion of patients with multiple territory lesions in the permanent RLS group(50%)was larger than that in the latent RLS group(27.91%;P=0.021).Posterior circulation was more likely to be affected in the latent RLS group than in the permanent RLS group(30.23%vs 8.82%,P=0.004).Permanent-large and latent-large RLS were both more likely to be related to multiple(P_(trend)=0.017 and 0.009,respectively),small(P_(trend)=0.035 and 0.006,respectively)and cortical(P_(trend)=0.031 and 0.033,respectively)lesions.The grade of RLS evaluated by c-TCD was correlated to the size of PFO determined by transesophageal echocardiography(r=0.758,P<0.001).CONCLUSION Distribution of the infarct suggested the possible type of RLS.Multiple,small and cortical infarcts suggest large RLS induced by a large PFO.
基金Supported by The Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project,No.20223357021 and No.20243357001Research Project of Teaching Reform in Shenzhen Second People’s Hospital,No.202209Guangdong Province Basic and Applied Basic Research Fund Project,No.2020B1515120061.
文摘BACKGROUND Patent foramen ovale(PFO)-related right-to-left shunts(RLSs)have been impli-cated in cryptogenic stroke and migraine,with larger shunts posing a higher risk.When used individually to detect RLS,contrast transcranial Doppler(cTCD)and contrast transthoracic echocardiography(cTTE)may yield false-negative results.Further,the literature exposes gaps regarding the understanding of the limitations of cTCD and cTTE,presents conflicting recommendations on their exclusive use,and highlights inefficiencies associated with nonsynchronous testing.AIM To investigate the accuracy of multimodal ultrasound to improve diagnostic efficiency in detecting PFO-related RLSs.METHODS We prospectively enrolled four patients with cryptogenic stroke(n=1),migraine(n=2),and unexplained dizziness(n=1)who underwent synchronized cTCD combined with cTTE.The participants were monitored and followed-up for 24 months.RESULTS cTTE identified moderate and large RLSs in patients with recurrent cryptogenic stroke and migraines,whereas cTCD revealed only small RLSs.Moderate and large RLS were confirmed on combined cTTE and cTCD.After excluding other causes,both patients underwent PFO occlusion.At 21-and 24-month follow-up examinations,neither stroke nor migraine had recurred.cTTE revealed a small RLS in a third patient with unexplained dizziness and a fourth patient with migraines;however,simultaneous cTCD detected a large RLS.These patients did not undergo interventional occlusion,and dizziness and headache recurred at the 17-and 24-month follow-up examin-ations.CONCLUSION Using cTTE or cTCD may underestimate RLS,impairing risk assessments.Combining synchronized cTCD with cTTE could enhance testing accuracy and support better diagnostic and therapeutic decisions.
文摘BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.
文摘BACKGROUND： It has been proved that brain electrical activity mapping （BEAM） and transcranial Doppler （TCD） detection can reflect the function of brain cell and its diseased degree of infant patients with moderate to severe hypoxic-ischemic encephalopathy （HIE）. OBJECTIVE： To observe the abnormal results of HIE at different degrees detected with BEAM and TCD in infant patients, and compare the detection results at the same time point between BEAM, TCD and computer tomography （CT） examinations. DESIGN ： Contrast observation SETTING： Departments of Neuro-electrophysiology and Pediatrics, Second Affiliated Hospital of Qiqihar Medical College. PARTICIPANTS： Totally 416 infant patients with HIE who received treatment in the Department of Newborn Infants, Second Affiliated Hospital of Qiqihar Medical College during January 2001 and December 2005. The infant patients, 278 male and 138 female, were at embryonic 37 to 42 weeks and weighing 2.0 to 4.1 kg, and they were diagnosed with CT and met the diagnostic criteria of HIE of newborn infants compiled by Department of Neonatology, Pediatric Academy, Chinese Medical Association. According to diagnostic criteria, 130 patients were mild abnormal, 196 moderate abnormal and 90 severe abnormal. The relatives of all the infant patients were informed of the experiment. METHOOS： BEAM and TCD examinations were performed in the involved 416 infant patients with HIE at different degrees with DYD2000 16-channel BEAM instrument and EME-2000 ultrasonograph before preliminary diagnosis treatment （within 1 month after birth） and 1,3,6,12 and 24 months after birth, and detected results were compared between BEAM, TCD and CT examinations. MAIN OUTCOME MEASURES： Comparison of detection results of HIE at different time points in infant patients between BEAM. TCD and CT examinations. RESULTS： All the 416 infant patients with HIE participated in the result analysis. （1） Comparison of the detected results in infant patients with mild HIE at different time points after birth between BEAM, TCD and CT examinations： BEAM examination showed that the recovery was delayed, and the abnormal rate of BEAM examination was significantly higher than that of CT examination 1 and 3 months after birth [55.4%（72/130）vs. 17.0% （22/130 ）,x^2=41.66 ;29.2% （ 38/130 ） vs. 6.2% （ 8/130 ）, x^2=23.77, P 〈 0.01 ], exceptional patients had mild abnormality and reached the normal level in about 6 months. TCD examination showed that the disease condition significantly improved and infant patients with HIE basically recovered 1 or 2 months after birth, while CT examination showed that infant patients recovered 3 or 4 months after birth. （2） Comparison of detection results of infant patients with moderate HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination 1,3,6 and 12 months after birth [90.8% （178/196）,78.6% （154/196）,x^2=4.32,P 〈 0.05;64.3% （126/196）,43.9% （86/196） ,x^2=16.44 ;44.9% （88/196） ,22.4% （44/196）,x^2=22.11 ;21.4% （42/196）, 10.2% （20/196）,x^2=9.27, P 〈 0.01]. BEAM examination showed that there was still one patient who did not completely recovered in the 24^th month due to the relatives of infant patients did not combine the treatment,. TCD examination showed that the abnormal rate was 23.1%（30/196）in the 1^st month after birth, and all the patients recovered to the normal in the 3^rd month after birth, while CT examination showed that mild abnormality still existed in the 24^th month after birth （1.0% ,2/196）. （3） Comparison of detection results of infant patients with severe HIE at different time points between BEAM, TCD and CT examinations： The abnormal rate of BEAM examination was significantly higher than that of CT examination in the 1^st, 3^rd, 6^th and 12^th months after birth[86.7% （78/90）,44.4% （40/90）,x^2=35.53;62.2% （56/90）,31.1% （28/90）,x^2=17.51 ;37.8% （34/90）,6.7% （6/90）, x^2=27.14, P 〈 0.01]. BEAM examination showed that mild abnormality still existed in 4 infant patients in the 24^th month after birth. TCD examination showed that the abnormal rate was 11.1% （10/90） in the 3^rd month after birth, and all the infant patients recovered in the 6^th month after birth. CT examination showed that the abnormal rate was 6.7%（6/90） in the 12^th month after birth, and all of infant patients recovered to the normal in the 24^th month after birth.CONCLUSION ： BEAM is the direct index to detect brain function of infant patients with HIE, and positive reaction is still very sensitive in the tracking detection of convalescent period. The positive rate of morphological reaction in CT examination is superior to that in TCD examination, and the positive rate is very high in the acute period of HIE in examination.
文摘Objective:For patients with early acute cerebral infarction(ACI),transcranial Doppler ultrasound was used in the clinical examination,and its application effect was observed and analyzed.Methods:This study was carried out between October 2018 and October 2019.50 patients with ACI included as the research object was evaluated by transcranial Doppler and CT examination,and the application of the two examination methods was compared.Results:The results of transcranial Doppler examination showed that the abnormal rate of blood flow velocity and the ratio of both sides(VACA)in patients with early ACI was higher than that of CT examination.Conclusion:With the impact on the location and area of vascular occlusion in patients,VACA can effectively reflect the status and effectiveness of the collateral circulation function of the patient’s pia vessels during cerebral infarction.
文摘Aim. Comparison of the trascranial Doppler (TCD) characteristics of cerebral circulation in persistent vegetative status (PVS), locked in syndrome and brain death patients. Methods. Using TCD ultrasound to detect the flow velocity and waveform patterns of middle cerebral artery (MCA) and basilar artery (BA) in patients with PVS, locked in syndrome and brain death. Results. The mean velocities of middle cerebral artery (Vmca) and basilar artery (Vba) were 30.0cm/s and 24.3cm/s in PVS patients respectively, which decreased 45.0% and 14.4% in comparing with normal value. For patients with locked in syndrome, Vmca and Vba were 49.7cm/s and 9.8cm/s, which decreased 5.0% and 61.7% than the normal value respectively. These results showed that the decrease of anterior circulation was predominant in PVS, and the decrease of posterior circulation was predominant in locked in syndrome. A unique diastolic reverse flow, short peak systolic wave or undetectable flow signal in middle cerebral artery were predominant in brain death patients, which was completely different from that of either PVS or locked in syndrome. Conclusion. TCD was a valuable tool in distinguishing PVS, locked in syndrome and brain death patients according to the differences in velocities and patterns of anterior and posterior cerebral arteries.
文摘BACKGROUND： Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide （NO） in vivo. OBJECTIVE： To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency （VBI） through transcranial Doppler （TCD） detection and serum NO content and indirect effect of TCD on cerebral blood flow changes. DESIGN： Randomized grouping and controlled clinical study. SETTING： Department of Neurology, the Fourth People＇s Hospital of Jinan. PARTICIPANTS： A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People＇s Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confumed consent. They were randomly divided into low-dose treatment group （n =60）, high-lose treatment group （n =30） and control group （n =40）. METHODS： Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition, ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment. According to the TCD test, VBI patients were divided into two groups （high-low flow velocity）. The vertebral artery （VA） and basal artery （BA） of left or right sides were detected by 2 Hz detector via occipital window. MAIN OUTCOME MEASURES： ①Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD before treatment, after treatment for one course; ②content of serum NO indirectly measured by using nitric acid disoxidation technique. RESULTS： All 130 VBI patients were involved in the final analysis. ①Changes of hemodynamic indexes： Systolic phase of VA and diastole phase of BA were higher in low-dose treatment group than that in the control group after first treatment, and there was significant difference （P 〈 0.05）; meanwhile, systolic phase and diastole phase of VA and systolic phase of BA were also higher in treatment group than that in the control group after one course （P 〈 0.05）. However, both systolic phase and diastole phase of VA and BA were lower in high-dose treatment group than that in the control group after first treatment and one course, and there was significant difference （P 〈 0.05）. ②Content of serum NO： After first treatment, there was no significant difference between low-dose treatment group and high-dose treatment group （P 〉 0.05）; but both groups were higher than control group, and there was significant difference （P 〈 0.05, 0.01）. CONCLUSION： NO vector of ultrasonic atomizing inhalation can improve VBI so as to improve cerebral blood-supply state.
文摘Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses Methods In twenty two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD) During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO 2) using dual wavelength spatially resolved near infrared spectroscopy Results All patients experienced an uneventful recovery Flow in the middle cerebral artery became undetectable at ASCP < 5?ml·kg 1 ·min 1 , so adjustments from a 15-20?ml·kg 1 ·min 1 baseline were used to maintain rSO 2 above 50% Furthermore, ASCP flow was highly correlated ( P <0 01) with both peak middle cerebral artery velocity and rSO 2 ( r =0 86 and 0 96, respectively) Conclusion Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81100855） and the Health Department of Jilin （No. 2009Z064）. Conflict of interest： none.
文摘Objective To discuss the clinical ultiliazation and significance of microembolus detection by transcranial Doppler （TCD） sonography in intracranial stenosis-occlusive disease. Data sources All 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 selection Original articles and reviews were selected if they were related to the clinical utilization of microembolus detection in intracranial stenosis-occlusive disease. Results Intracranial 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. Conclusion Microembolus detection by TCD sonography plays an important role in the cerebral ischemic stroke patients with intracranial stenosis.
基金This study was supported by grants from the National Natural Science Foundation of China ＂Study on protective mechanism of the retinal ganglial cell （RGE） of ocular ischemic syndrome （OIS）＂ （No. 81173412）, Beijing Natural Science Foundation ＂Study on correlation between the hemodynamic changes of ocular ischemic syndrome and Toll-like receptors signal pathway （No. 7122046）, and Capital Medical Academy of Key Laboratory Ophthalmology Open Research Topic ＂Study on injury mechanism of the retinal ganglial cell （RGE） of ocular ischemic syndrome （OIS）＇.
文摘The ophthalmic artery （OA） is a main branch of the internal carotid artery （ICA）. Severe internal carotidartery stenosis or occlusion may not only affect the blood supply to the brain, but may also cause OA insufficiency, leading to ocular ischemia. Therefore, research on the hemodynamic changes in the OA in patients with ICA stenosis or occlusion has increasingly attracted more ophthalmologists＇ attention.1 Transcranial Doppler （TCD） is simple and noninvasive, has been widely used in the inspection of cerebrovascular disease,
文摘Acupuncture moxibustion has been recognized to be effective for treatment of cerebral ischemia, but there are still some problems such as undefined criteria for evaluating the effectiveness and unchecked selection of acupoints. In the late 1980s, cerebrovascular examination was revolutionized in China
文摘Cardio-cerebral coupling(CCC)refers to the dynamic interplay between cardiac function and cerebral blood flow,essential for maintaining hemodynamic stability.Disruptions in CCC are particularly relevant in critical care,where they can exacerbate primary and secondary brain injuries.Ultrasound-based techniques,including transcranial Doppler,transcranial color-coded Doppler,and echocardiography,provide non-invasive methods to assess this relationship at the bedside.This scoping review explores the pathophysiology of CCC,ultrasound methodologies for its evaluation,and its clinical relevance.Key mechanisms such as cerebral autoregulation and neurovascular coupling are discussed,along with ultrasound-derived parameters like pulsatility index,resistance index,and cerebral perfusion pressure.While ultrasound is a valuable tool,its limitations include operator dependency and equipment variability.Emerging evidence suggests that ultrasound-guided protocols,including ultrasound-guided cardio-cerebral resuscitation protocol and ultrasound-guided brain injury treatment protocol,may improve resuscitation strategies and neurocritical care monitoring.Despite its potential,further research is necessary to standardize assessment methods and integrate ultrasound-based CCC evaluation into routine clinical practice.Ongoing multicenter studies are expected to provide robust evidence supporting its clinical utility in managing brain-injured patients.
文摘Management of intracranial hypertension(IH)has improved in the last decades driven by advancements in monitoring technologies and a deeper understanding of its pathophysiology.Although intracranial pressure(ICP)catheters are still recommended by current guidelines for monitoring patients at risk of IH,these methods are not without limitations.Challenges include procedural complications,availability of these devices in many healthcare settings and technical issues.In this context,management in the absence of ICP monitoring is common and now it can be augmented by intensivist-led point-of-care ultrasound,which includes tools such as transcranial doppler,optic nerve sheath measurement and brain ultrasound.These methods offer anatomic information that can sometimes withhold repeated head computed tomography(CT)scans,but they are also a window into ICP dynamics without the associated risks of invasive monitoring and are reasonable alternatives for guiding treatment,provided an integration between neurological examination,head CT anatomical findings and noninvasive monitors is considered.This manuscript synthesizes the evidence for using invasive ICP monitoring and methods for non-invasive monitoring,more focused on the role of ultrasound,given its wider availability.We also propose a practical approach of how to integrate this information at bedside to avoid both under and overtreatment,by embracing a clinical epidemiology paradigm to guide management decisions.
文摘Objective To explore the therapeutic efficacy and mechanism of acupuncture at Lieque （列缺 LU 7） in treatment of cervical vertigo （CV）. Methods Forty CV patients met the inclusion criteria were enrolled and treated with acupuncture at bilateral LU 7 points, once daily with 10 times as a course. The changes of blood flow velocity in bilateral vertebral artery and basilar artery were observed through transcranial doppler sonography （TCD） before treatment, after deqi with acupuncture and after a course of treatment, respectively. The scores and therapeutic efficacy on clinical symptoms were assessed according to CV symptoms and the functional assessment scale as well as the Criteria-for Diagnosis and Curative Effect in TCM Syndromes before treatment and after a course of treatment. Results Before treatment, after deqi and after a course of treatment, the blood flow velocity of basilar artery （BA）, left vertebral artery （LVA） and right vertebral artery （RVA） in 22 patients with a decreased blood flow velocity were respectively 23.20±4.84 vs 26.30 ± 4.17 vs 29.20 ± 4.20 （mm/s, BA）, 21.65 ± 3.62 vs 24.20 ± 2.89 vs 26.40 ± 3.62 （mm/s, LVA） and 21.90±3.04 vs 24.25±3.01 vs 26.50_±3.95 （mm/s, RVA）, while in 18 patients with an increased blood flow velocity were respectively 39.94 ± 8.24 vs 35.17 ± 4.84 vs 32.06 ± 3.49 （mm/s, BA）, 41.83 ± 5.64 vs 37.28 ± 2.32 vs 35.61 ± 2.09 （mm/s, LVA） and 37.11 ± 9.83 vs 32.22 ± 6.13 vs 28.11 ± 4.12 （mm/s, RVA）. Except that the difference of blood flow velocity of RVA was not significant in patients with an increased blood flow velocity before treatment and after deqi （P 〉 0.05）, the Vm of all vessels in 40 patients was improved after deqi with acupuncture and a course of treatment （P〈0.01, P〈0.05）. According to CV symptoms and the functional assessment scale, before treatment and after a course of treatment, the scores were 15.68 ± 5.35 and 26.30 ± 3.76, respectively, indicating that after a course of treatment, the symptoms were significantly improved （P 〈 0.01）. According to the Criteria for Diagnosis and Curative E.f]ect in TCM Syndromes, after a course of treatment, the total effective rate was 100% （40/40） and the cured rate was 55.0% （22/40）. Conclusion Acupuncture at LU 7 not only improves the blood supply of vertebral-basilar artery in CV patients, but also has a significant curative effect on improving the clinical symptoms.
基金supported by the Science and Technology Planned Project of Bureau of Education of Guangzhou, China (No. 08A 002)the grant from Zhejiang Dazhong Pharmaceutical Company
文摘Objective To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin. Methods Sixty-eight patients who had ischemic stroke during the recent 1-6 months were recruited and randomized into cilostazol or aspirin group. Cerebrovascular condition was assessed by magnetic resonance angiography （MRA） and transcranial doppler ultrasonography （TCD） at the beginning of the study and after 12-month medication. Results During the clinical follow-up, ischemic stroke recurred in 2 patients in cilostazol group, while in aspirin group, one case of ischemic stroke recurrence and one case of acute myocardial infarction were found. MRA revealed that in aspirin group, the percentages of patients experiencing aggravation and attenuation of cerebrovascular condition were 3.3% and 6.7%, respectively, while in aspirin group, they were 3.3% and 10%, respectively. Moreover, TCD revealed that 26.9% of the patients in aspirin group and 14.3% of the patients in cilostazol group experienced aggravation of cerebrovascular condition. However, the systolic peak flow velocity of the previously abnormal arteries increased by 42.9% after 12-month medication of cilostazol, which was significantly higher than that after aspirin medication （27.5%） （P = 0.04）. Furthermore, as a major side effect of antiplatelet therapy, the frequrency of bleeding was much less in cilostazol group （0 case in cilostazol group vs 5 in aspirin, P 〈 0.05）. Conclusion Cilostazol is as effective as aspirin in preventing the aggravation of cerebral arteries in secondary prevention of ischemic stroke. Besides, it is more safe. Cilostazol can increase the systolic peak flow velocity of cerebral arteries, which may improve the blood supply of focal ischemia.
文摘Objective To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions （IA- OLs）, and their correlation with thyroid function. Methods We 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. Results Among 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 I3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the intemal 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 IA- OLs 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. Conclusion IAOLs 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.
文摘The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity （BaPWV） and ankle-bra- chial index （ABI） are known to be associated with ischemic cardiovascular and cerebrovascular diseases, whether these measures predict the risk of ischemic cerebrovascular disease in diabetic patients remains unclear. 117 patients with type 2 diabetes were enrolled in this study. According to the results of head magnetic resonance imaging, the patients were divided into a diabetes-only group （n = 55） and a diabetes and ischemic stroke group （n = 62）. We then performed ABI and BaPWV examinations for all patients. Compared with the diabe- tes-only group, we found decreased ABI and increased BaPWV in the diabetes and ischemic stroke group. Multivariate logistic regression analyses revealed that BaPWV and ABI were risk factors for ischemic stroke in patients with type 2 diabetes. Our findings indicate that decreased ABI and increased BaPWV are objective indicators of increased risk of ischemic stroke in patients with type 2 diabetes.
