Transcranial dopplerography in acute left-hemispheric ischemic stroke.

Abstract

Introduction: Stroke is the second most common cause of morbidity worldwide and is the leading cause of acquired disability. Emergent brain imaging is essential for evaluation of acute ischemic stroke. Transcranial dopplerography in triplex mode is a non-invasive approach to obtain quantitative parameters of blood flow. Objective: Transcranial dopplerography assessment of blood flow parameters in patients with left hemispheric stroke, caused by atherosclerosis of the internal carotid and middle cerebral artery. Materials and methods: A retrospective analysis of the results of transcranial dopplerography (TCD) of the middle cerebral artery was performed in 104 patients with left hemispheric ischemic stroke (IS) caused by atherosclerosis of the internal carotid (IC) and middle cerebral arteries (MCA). The age of the subjects was 41-80 years, among them 49 (47.1%) men and 55 (52.9%) women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), average systolic velocity (TAMX), the resistance and pulsativity indexes (RI, PI) in MCA were determined. Results: In 90 (86.5+3.4%) patients, Vs in the MCA did not exceed 70 cm/s and averaged 56.7 ± 6.6 cm/s. In 14 (13.5+3.4%) patients Vs varied within 71-118 cm/s and averaged 87.9 ± 9.3 cm/s. Among patients with a reduced velocity of blood flow in 83 (92.2%) cases, according to CT and MRI data, the size of the affected lesion in the left hemisphere varied within 1.0-2.0 cm, in 7 (7.8%) cases was less than 1.0 cm. TCD in 79 (87.8%) cases showed MCA stenosis, which was confirmed in 76 cases with MRI angiography. Vs among patients under 60 years old was 56.7 ± 6.6 cm/s, more than 60 years-48.5 ± 5.9 cm/s; Vd-19.0 ± 2.8 cm/s and 13.0 ± 2.0 cm/s; TAMX-27.5 ± 4.3 cm/s and 25.2 ± 4.2 cm/s; RI=0.67 ± 0.04 and 0.74 ± 0.04; PI-1.37 ± 0.09 and 1.41 ± 0.08 respectively. On the contralateral side, Vs was increased, Vd decreased. The diastolic blood flow velocity between patients <60 and >60 years was significantly different (P<0.05). In a patient with IS Vs in the deep medial cerebral vein was 24.6+3.8 cm/s; in the basal vein of the brain -24.6+3.8 cm/s; in the large vein of the brain -26.2+2.4 cm/s; in the direct sinus, 31.7 ± 2.4 cm/s, respectively. Conclusion: In patients with hemispheric chemical stroke, stenosis of the middle cerebral artery is often observed, a systolic blood flow velocity less than 70 cm/s, an increase in the resistance and pulsation index. On the contralateral side, in persons up to 60 years of age, the blood flow velocity may be slightly increased in comparison with healthy individuals. Reduction of systolic blood flow velocity, increase in resistance index more than 0.70, pulsative index more than 1.35, presence of deep incision on Doppler spectrum of blood flow in middle cerebral artery are prognostic signs of unfavorable course of ischemic stroke. With ischemic stroke on the side of the lesion, visualization of the deep veins of the brain improves because of the increase in speed in them.