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Three-dimensional transcranial Doppler in acute ischemic stroke in the territory of the middle cerebral artery: Clinical and CT correlation

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Abstract

We studied 34 patients with acute ischeiic stroke in the territory of the middle cerebral artery (MCA) by three-dimensional transcranial Doppler (TCD-3D). The parameters analyzed were: mean blood flow velocity, systolic and diastolic velocities; indices of pulsatility, hemisphere asymmetry and pulsatility transmission. Of the 34 patients 11 presented marked slowing of flow velocity in the MCA on the infarct side with an asymmetry index (AI) of over 40%, 8 patients with slightly reduced flow velocity in the MCA and an AI of 25–40%, 2 patients in whom there was indirect evidence of collateral circulations in the anterior cerebral artery distribution together with slowing of MCA flow; 5 patients had stenosis of the MCA, 9 patients showed no alterations of the Doppler parameters. The correlation between neurological symptom pattern and AI was significant (r=0.76). Noninvasive, easy to perform, performable at once and reliable, TCD-3D is a great improvement on traditional transcranial Doppler and is especially useful in assessing the hemodynamics of the cerebral circulation in ischemic stroke.

Sommario

Abbiamo studiato 34 pazienti affetti da stroke ischemico acuto, nel territorio dell'Arteria Cerebrale Media (MCA), utilizzando il Doppler transcranico in 3 dimensioni (TCD-3D). I parametri analizzati sono: velocità media; velocità sistolica e diastolica; gli indici di pulsatilità, di asimmetria interemisferica e di trasmissione della pulsatilità.

Dei 34 pazienti: 11 hanno presentato un rallentamento marcato della velocità di flusso della MCA dell'emisfero infartuato, con un indice di asimmetria interemisferico (AI) maggiore del 40%; 8 pazienti un rallentamento modesto del flusso della MCA, con AI compreso tra 25–40%; in 2 pazienti abbiamo evidenziato, indirettamente, circoli collaterali di pertinenza dell'arteria cerebrale anteriore, in associazione ad un rallentamento del flusso della MCA; 5 pazienti mostravano una stenosi dell'MCA. Infine 9 pazienti non hanno presentato alterazioni dei parametri Doppler. La correlazione tra sintomatologia neurologica e AI è risultata significativa (r=0.76). La non invasività, la facile ed immediata esecuzione e soprattutto, la buona attendibilità dell'esame, ci consente di affermare che il TCD-3D, introducendo miglioramenti sostanziali nella metodica del Doppler transcranico tradizionale, risulta particolarmente utile nella valutazione emodinamica della circolazione cerebrale in caso di stroke ischemico.

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  1. Clinica Neurologica, Università G. D'Annunzio di Chieti, Chieti, Italy

    Viola S., Antonacci R., D'Annunzio S., Faricelli A., Aquilone L., Gambi D. & Malatesta G.

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  1. Viola S.
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  2. Antonacci R.
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  3. D'Annunzio S.
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  4. Faricelli A.
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  5. Aquilone L.
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  6. Gambi D.
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  7. Malatesta G.
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Viola, S., Antonacci, R., D'Annunzio, S. et al. Three-dimensional transcranial Doppler in acute ischemic stroke in the territory of the middle cerebral artery: Clinical and CT correlation. Ital J Neuro Sci 12, 545–555 (1991). https://doi.org/10.1007/BF02336950

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