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At least 631 records · Page 35Linked to original sources
PubMed1988

Basilar artery disease--clinical outcome and Doppler sonographical follow-up.

In the past 5 years we have investigated 29 patients with symptomatic basilar artery stenoses (14 cases) and occlusions (14) and a patent primitive trigeminal artery with thin-calibered basilar and vertebral arteries (1) using directional continuous-wave Doppler sonography of the vertebral arteries. A total of 19 patients survived, and 17 of them were clinically and sonographically reexamined after 40.4 +/- 15.8 months (mean +/- SD). Among the 8 patients with basilar stenoses, 6--with no further transient ischemic attacks (TIAs) in the interval--exhibited an increase in the summed modified Pourcelot indices (relative end-diastolic flow velocities) of the vertebrals by 0.18 +/- 0.16; the other 2 showed a decrease by 0.26 each, in 1 case temporally related to a TIA, in the 2nd case without further clinical deterioration. In the 8 survivors with basilar occlusions, 5 remained--by sonographic criteria--unchanged with summed modified Pourcelot indices of the vertebrals of 0.00, while 3 patients exhibited a slight increase in the summed modified Pourcelot indices of 0.13 +/- 0.03. While the difference between the outcome of subsets of patients treated with regimens of 30,000-40,000 units heparin/day or phenprocoumon and less radical drugs were statistically not significant, the former regimen appeared clinically more efficacious in preventing further deterioration in approximately two-thirds of the patients affected. Due to the potential recurrence of neurological symptoms, a treatment period with phenprocoumon of 6 months after discharge from hospital appears justified. Due to these therapeutic efforts, approximately half of the patients initially affected survived with no or only a mild neurological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Indication for invasive diagnostic studies and surgical therapy in cerebral ischemia, based on results of non-invasive transcranial Doppler sonography.

In order to better define patients who might benefit from cerebral revascularization surgery, transcranial Doppler sonography was used in more than 480 patients. Thus invasive diagnostic studies could be limited to probable surgical candidates. Transcranial Doppler sonography has proven to be reliable for the study of the degree of efficacy of intracranial collateral pathways in hemodynamic borderline situations. Over the last 4 years, the application of the algorithm presented in this paper resulted in a reduction of the number of candidates for surgical revascularization to 19.

Algorithms↗
PubMed1991

Comparison of Doppler CO2 test, patterns of infarction in CCT, and clinical symptoms in carotid artery occlusions.

In patients with an internal carotid artery (ICA) occlusion the CO2 reactivity (autoregulatory reserve) is supposed to give information about the function of the collateral supply. To prove this hypothesis we compared the CO2 reactivity measured by transcranial Doppler sonography to the ipsilateral clinical symptoms and the patterns of infarction in cranial computed tomography (CCT). We studied 251 cases of ICA occlusion. Of the 141 cases with normal autoregulatory reserve, 37 (27%) had recently developed an ipsilateral neurological deficit. Of the 44 cases with exhausted CO2 reactivity, 28 (64%) had experienced an event. The difference is highly significant (p less than 0.0001). In 59 of the 75 patients for whom CCT images were available, we found signs of vascular-ischemic lesions. Of the 30 patients with hemodynamic infarctions, 13 showed an exhausted autoregulatory reserve, while of 19 cases with territorial infarctions only 1 and of 10 with lacunar infarctions none had an exhausted CO2 reactivity. The difference is significant (p less than 0.01).

Blood Flow Velocity↗
PubMed1991

Vasospasm after traumatic subarachnoid haemorrhage: transcranial Doppler evaluation. Case report.

A case of vasospasm after traumatic subarachnoid haemorrhage (SAH) is reported here. Transcranial Doppler Sonography (TCD) was used to evaluate mean flow velocity (MFV) changes of the basal cerebral arteries related to vasospasm. Acceleration of MFV of the right middle cerebral artery (MCA) indicating vasospasm was first noted on TCD evaluation, and then proved by carotid angiography (CAG). Evaluation of all TCD results revealed that the process of relaxation or normalization of the spastic artery started from the proximal side of the basal intracranial artery and gradually moving to the distal side. This interesting phenomenon could be a common process found in vasospasm cases.

Blood Flow Velocity↗
PubMed1996

Use of transcranial real-time ultrasonography for programming a shunt valve system.

For patients who suffer from hydrocephalus that is difficult to treat because of impaired intracranial compliance, a programmable shunt system may be a helpful alternative. However, especially during the first weeks after implantation, many radiological follow-up studies are necessary to achieve the optimum pressure level. The authors present the case of a 7-year-old boy who suffered from posthemorrhagic hydrocephalus and did not respond to conventional shunt valve systems. After implantation of a programmable shunt system, achieving the optimum craniospinal fluid (CSF) pressure level was difficult because the symptoms of over- and under-drainage were similar. Using transcranial real-time ultrasonography for evaluation of the diameter of the intracranial CSF spaces, we were able to adjust the correct pressure level without long-term intracranial pressure monitoring or daily computed tomography, which otherwise would have been necessary because of the ambiguous symptomatology. Transcranial real-time ultrasonography (TCUS) displays an image of the intracranial parenchyma and CSF spaces through the intact temporal bone and is a valuable, serially applicable bedside monitoring technique for patients requiring close imaging follow-up.

Cerebral Hemorrhage↗
PubMed1987

Cerebral blood flow velocity pattern in healthy and asphyxiated newborns: a controlled study.

In a controlled study serial determinations of cerebral blood flow velocity using Doppler ultrasound and repeated real-time ultrasonographic- or computerized axial tomographic studies of the brain were performed in 17 (nearly) full-term newborns who experienced perinatal asphyxia and in 17 healthy matched controls during the first week of life. A higher cerebral blood flow velocity was found during the first 4 days of life, indicating a lower cerebrovascular resistance in the asphyxiated infants compared to the control infants. These haemodynamic changes coincided with cerebral oedema and neurological abnormalities. It is speculated that the changes in the cerebral circulation in asphyxiated infants are at least partly caused by cerebral oedema-induced increase of intracranial pressure due to severe perinatal asphyxia. Serial Doppler ultrasound investigations of the brain may be a useful non-invasive method for early detection and follow-up of the consequences of severe perinatal asphyxia.

Asphyxia Neonatorum↗
PubMed1989

Cranial sonographic evaluation in children with meningomyelocele.

Over a period of 5 years, 25 children between 1 day and 26 months of age were prospectively evaluated because of the presence of meningomyeloceles. Cranial sonography was used to ascertain the types of associated cranial alterations. Twenty-three children (92%) presented signs of Chiari II malformation. In only two (8%) were the ultra-sonographic results normal. The abnormalities detected were classified as alterations of the ventricular system, extraventricular alterations, and associated findings. The most frequent alteration of the ventricular system was the "bat-wing" configuration of the frontal horns, which appeared in 22 children (88%). Among the extraventricular alterations, 23 children (92%) had a downward displaced cerebellum, obliterated basal cisterns and low positioning of the tentorium cerebelli. Associated findings were a polymicrogyria in 1 case and intracranial hemorrhage in 2. The 23 children with Chiari II malformation were followed up clinically and sonographically. Our findings were similar to those of other published series. In spite of the introduction of magnetic resonance imaging, we consider cranial sonography to be an inexpensive and convenient method of evaluating the existence of Chiari II malformation in the child with meningomyelocele and of following up its evolution after shunt procedures.

Arnold-Chiari Malformation↗
PubMed1993

Early diagnosis of perinatal cerebral lesions in apparently normal full-term newborns by ultrasound of the brain.

The brains of 1000 consecutive, clinically normal, full-term neonate without signs of perinatal distress were examined by ultrasound 3 days postpartum. We found 35 cases of intracranial haemorrhage (periventricular, choroid plexus and intraventricular); 34 possible sequelae of bleeding (subependymal and choroid plexus pseudocysts; local dilatation of the lateral ventricles) and 21 morphological aberrations. Most of these 90 abnormalities were checked several times. Four children with intracranial haemorrhage developed symptoms (3 hemipareses, 1 infantile spasm) within a year of birth. No child without sonographic abnormalities has so far been recognized as developing a clinical deficit.

Brain↗
PubMed1993

Infantile panthalamic infarct with a striking sonographic finding: the "bright thalamus".

A "bright thalamus" is not uncommonly observed in cranial sonograms of asphyxiated neonates, but not those of older infants. Three infants, aged 9-14 months, developed acute onset of seizures and disturbance of consciousness after a minor prodromal illness. Bilateral thalamic infarcts were demonstrated by ultrasonography and CT. One patient expired from causes not directly related to the infarcts; the other two survived with severe neurological sequelae.

Cerebral Infarction↗
PubMed1993

Prenatal brain atrophy due to a giant vein of Galen malformation.

We report a full-term newborn girl with a giant vein of Galen malformation and extreme cerebral atrophy of prenatal origin. She presented on the 3rd day of life with intractable congestive heart failure. The diagnosis of the vascular malformation was confirmed by ultrasound and magnetic resonance imaging.

Atrophy↗
PubMed1992

Successful treatment of neonatal aneurysmal dilatation of the vein of Galen: the role of prenatal diagnosis and trans-arterial embolization.

We report a neonate with aneurysmal dilatation of the vein of Galen diagnosed prenatally by color Doppler sonography and MRI at 37 weeks' gestation. The child was treated by transarterial embolization of micro-coils 2 and 8 days after birth. The aneurysmal dilatation of the vein of Galen markedly decreased after embolization and the patient is developing normally at 2 years 5 months of age. Prenatal diagnosis and early intervention by transarterial embolization produced in a good outcome in this patient.

Adult↗
PubMed1975

[The advantages and limitations of an automatic ultrasound determination of the cerebral midline--a study of 1889 cases].

The examination of the brain with ultrasound has become an indispensible diagnostic tool in all cases of intracranial pathology. Valuable information is obtained both in emergencies and in follow-up studies. Since long practice is necessary before the results of echoencephalograms can be interpreted accurately, a need was felt for a standardization of the examination which would eliminate the subjective influence of the investigator. The automatic midline computer, called Midliner, which has recently become available, makes fewer demands on the experience of the investigator although the diagnostic possibilities are not as broad. The position of the midline echo is of primary interest, although the width of the third ventricle can be successfully determined in occasional cases. this study, which presents the results of the Midliner examinations in three clinics, is grouped according to diagnosis. Through a comparison with conventional A-scan echoencephalograms, as well as with neuroradiological and operative findings in 1889 cases, the reliability of this method is clearly demonstrated. The advantages and disadvantages of the examination are discussed and the field of application indicated.

Adolescent↗
PubMedDate not supplied

Cerebral ultrasonography before and after cardiac surgery in infants.

Cerebral ultrasonography was performed in 66 infants before and after open heart surgery in order to study the incidence of cerebral complications. The underlying cardiac malformations were ventricular septal defect (n = 28), transposition of the great arteries (n = 11), tetralogy of Fallot (n = 8), complete atrioventricular septal defect (n = 5), total anomalous pulmonary venous drainage (n = 3), truncus arteriosus communis (n = 2), and complex cardiac malformations (n = 9). In 60 of the 66 infants ultrasonography of the brain preoperatively was normal, 3 had minor structural abnormalities, and 3 had ventriculomegaly of various degrees. Postoperatively, 46 infants had a normal brain ultrasound scan; 6 had slight structural abnormalities; and 5 had slight symmetric or asymmetric widening of the ventricles. Five infants showed severe ventriculomegaly with cerebral atrophy, and in 4 patients there was intracerebral hemorrhage, associated in 2 cases with severe ventriculomegaly. On repeat examinations it was found that up to 4 weeks after the operation an initially normal cerebral ultrasound scan could convert to a pathologic one. Most of those children who showed significant deterioration on the cerebral ultrasound scan suffered from complex cardiac malformations or had severe problems during the postoperative period.

Brain Damage, Chronic↗