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October 1994, Vol 51, No. 10 >
Article | October 1994

Transcranial Doppler Sonography Is at Present of Limited Clinical Value

N. M. Bornstein, MD; J. W. Norris, MD
Arch Neurol. 1994;51(10):1057-1059. doi:10.1001/archneur.1994.00540220105022
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Transcranial Doppler sonography (TCD) is already an established diagnostic technique and of proven value in a variety of neurosurgical problems.1 Probably the most important clinical contributions are the monitoring of vasospasm in subarachnoid hemorrhage, identifying patients at risk of delayed ischemic deficits, and for selecting patients for prophylactic antivasospasm therapy2 or carotid occlusion.3 The TCD is also a reliable noninvasive method for monitoring the hemodynamic effects of treatment for arteriovenous malformations.4,5 Intraoperative TCD monitoring of blood flow velocity during carotid endarterectomy is relatively sensitive to hemodynamic events, yet its clinical usefulness has yet to be established.6,7 It has a developing role in the evaluation of intracranial pressure changes in patients with head trauma, since it is atraumatic and repeatable and may help to avoid operative insertion of a transducer in some cases.8,9

The TCD rapidly found a place in neurovascular research soon after the

REFERENCES

1 +
Newell DW, Aaslid R, eds. Transcranial Doppler . New York, NY: Raven Press, 1991;.
2 +
Grosset DG, Straiton J, du Trevou M, Bullock R.  Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes . Stroke . 1992;;23:674-679.
3 +
Giller CA, Steig P, Batjer HH, et al.  Transcranial Doppler ultrasound as a guide to graded therapeutic occlusion of the carotid artery . Neurosurgery . 1990;;26:307-311.
4 +
Hassler W, Burger R.  Arteriovenous malformations . In: Newell DW, Aaslid R, eds. Transcranial Doppler . New York, NY: Raven Press, 1991;: 123-135.
5 +
Petty GW, Massaro AR, Tatemichi TK, et al.  Transcranial Doppler ultrasonographic changes after treatment for arteriovenous malformations . Stroke . 1990;;21:260-266.
6 +
Halsey JH, McDowell HA, Gelmon S, Morawetz RB.  Blood velocity in the middle cerebral artery and regional cerebral blood flow during carotid endarterectomy . Stroke . 1989;;20:53-58.
7 +
Bass A, Krupski WC, Scheider PA, et al.  Intra-operative transcranial Doppler: limitations of the method . J Vasc Surg . 1989;;10:549-553.
8 +
Saunders FW, Cledgett P.  Intracranial blood velocity in head injury: a transcranial ultrasound Doppler study . Surg Neurol . 1988;;29:401-409.
9 +
Klingelhofer J, Conrad B, Benecke R, et al.  Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease . J Neurology . 1988;;235:159-162.
10 +
Kelly RE, Namon RA, Juang SH, et al.  Transcranial Doppler ultrasound of the middle cerebral artery in the hemodynamic assessment of internal carotid artery stenosis . Arch Neurol . 1990;; 47:960-964.
11 +
Schneider PA, Rossman MA, Bernstein EF, et al.  Effect of internal carotid artery occlusion on intracranial hemodynamics: transcranial Doppler evaluation and clinical correlation . Stroke . 1988;; 19:589-593.
12 +
Ringelstein EB, Sievers C, Ecker S, et al.  Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions . Stroke . 1988;;19:963-969.
13 +
Piepgras A, Schmiedek P, Leinsinger G, et al.  A simple test to assess cerebrovascular reserve capacity using transcranial Doppler sonography and acetazolamide . Stroke . 1990;;21:1306-1311.
14 +
Norris JW, Krajewski A, Bornstein NM.  The clinical role of the cerebral collateral circulation in carotid occlusion . J Vasc Surg . 1990;;12:113-118.
15 +
Hedera P, Traubner P, Bujdakova J.  Short-term prognosis of stroke due to occlusion of internal carotid artery based on transcranial Doppler ultrasound . Stroke . 1992;;23:1069-1072.
16 +
Schneider PA, Rossman MA, Bernstein EF, et al.  Noninvasive assessment of cerebral collateral blood supply through the ophthalmic artery . Stroke . 1991;;22:31-36.
17 +
Brass LM, Duterte DL, Mohr JP.  Anterior cerebral artery velocity changes in disease of the middle cerebral artery stem . Stroke . 1989;;20: 1737-1740.
18 +
Karnik R, Stelzer P, Slany J.  Transcranial Doppler sonography monitoring of local intra-arterial thrombolysis in acute occlusion of the middle cerebral artery . Stroke . 1992;;23:284-287.
19 +
Mull M, Aulich A, Hennerici M.  Transcranial Doppler ultrasonography versus arteriography for assessment of the vertebrobasilar circulation . J Clin Ultrasound . 1990;;18:539-549.
20 +
Droste DW, Harders AG, Rastogi E.  A transcranial Doppler study of blood flow velocity in the middle cerebral arteries performed at rest and during mental activities . Stroke . 1989;;20:1005-1011.
21 +
Kelly RE, Chang JY, Scheinman NJ, et al.  Transcranial Doppler assessment of cerebral flow velocity during cognitive tasks . Stroke . 1992;;23: 9-14.
22 +
Thie A, Fuhlendorf A, Spitzer K, Kunze K.  Transcranial Doppler evaluation of common and classic migraine, II: ultrasonic features during attacks . Headache . 1990;;30:209-215.
23 +
Caekebeke JFV, Ferrari MD, Zwetsloot CP, et al.  Antimigraine drug sumatriptan increases blood flow velocity in large cerebral arteries during migraine attacks . Neurology . 1992;;32:1522-1526.
24 +
Adams RJ, Nichols FT, Figueroa R, et al.  Transcranial Doppler correlation with cerebral angiography in sickle cell disease . Stroke . 1992;;23: 1073-1077.
25 +
Petty GW, Mohr JP, Pedley TA, et al.  The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation . Neurology . 1989;; 40:300-303.
26 +
Spencer MP, Thomas Gl, Nicholls SC, Sauvage LR.  Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography . Stroke . 1990;;21: 415-423.
27 +
Russell D, Madden KP, Clark WM, Sandset PM, Zivin JA.  Detection of arterial emboli using Doppler ultrasound in rabbits . Stroke . 1991;:22:253-258.
28 +
Teague SM, Sharma MK.  Detection of paradoxical cerebral echo contrast embolization by transcranial Doppler ultrasound . Stroke . 1991;;22: 740-745.
29 +
Padayachee TS, Parsons S, Theobold R, et al.  The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: a transcranial Doppler ultrasound investigation using membrane and bubble oxygenators . Ann Thorac Surg . 1987;;44:298-302.
30 +
Markus H, Loh A, Israel D, et al.  Microscopic air embolism during cerebral angiography and strategies for its avoidance . Lancet . 1993;;341: 784-787.
31 +
Bogdahn U, Becker G, Winkler J, et al.  Transcranial color-coded real-time sonography in adults . Stroke . 1990;;21:1680-1688.
32 +
Ackerstaff RGA, Keunen RMW, van Pelt W, et al.  Influence of biological factors on changes in mean cerebral blood flow velocity in normal ageing: a transcranial Doppler study . Neurol Res . 1990;;12:187-191.
33 +
Kontos HA.  Validity of cerebral arterial blood flow calculations from velocity measurements . Stroke . 1989;;20:1-3.
34 +
Polak JF, Dobkin GR, O'Leary DH, et al.  Internal carotid artery stenosis: accuracy and reproducibility of color Doppler-assisted duplex imaging . Radiology . 1989;;173:793-798.

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1 +
Newell DW, Aaslid R, eds. Transcranial Doppler . New York, NY: Raven Press, 1991;.
2 +
Grosset DG, Straiton J, du Trevou M, Bullock R.  Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes . Stroke . 1992;;23:674-679.
3 +
Giller CA, Steig P, Batjer HH, et al.  Transcranial Doppler ultrasound as a guide to graded therapeutic occlusion of the carotid artery . Neurosurgery . 1990;;26:307-311.
4 +
Hassler W, Burger R.  Arteriovenous malformations . In: Newell DW, Aaslid R, eds. Transcranial Doppler . New York, NY: Raven Press, 1991;: 123-135.
5 +
Petty GW, Massaro AR, Tatemichi TK, et al.  Transcranial Doppler ultrasonographic changes after treatment for arteriovenous malformations . Stroke . 1990;;21:260-266.
6 +
Halsey JH, McDowell HA, Gelmon S, Morawetz RB.  Blood velocity in the middle cerebral artery and regional cerebral blood flow during carotid endarterectomy . Stroke . 1989;;20:53-58.
7 +
Bass A, Krupski WC, Scheider PA, et al.  Intra-operative transcranial Doppler: limitations of the method . J Vasc Surg . 1989;;10:549-553.
8 +
Saunders FW, Cledgett P.  Intracranial blood velocity in head injury: a transcranial ultrasound Doppler study . Surg Neurol . 1988;;29:401-409.
9 +
Klingelhofer J, Conrad B, Benecke R, et al.  Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease . J Neurology . 1988;;235:159-162.
10 +
Kelly RE, Namon RA, Juang SH, et al.  Transcranial Doppler ultrasound of the middle cerebral artery in the hemodynamic assessment of internal carotid artery stenosis . Arch Neurol . 1990;; 47:960-964.
11 +
Schneider PA, Rossman MA, Bernstein EF, et al.  Effect of internal carotid artery occlusion on intracranial hemodynamics: transcranial Doppler evaluation and clinical correlation . Stroke . 1988;; 19:589-593.
12 +
Ringelstein EB, Sievers C, Ecker S, et al.  Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions . Stroke . 1988;;19:963-969.
13 +
Piepgras A, Schmiedek P, Leinsinger G, et al.  A simple test to assess cerebrovascular reserve capacity using transcranial Doppler sonography and acetazolamide . Stroke . 1990;;21:1306-1311.
14 +
Norris JW, Krajewski A, Bornstein NM.  The clinical role of the cerebral collateral circulation in carotid occlusion . J Vasc Surg . 1990;;12:113-118.
15 +
Hedera P, Traubner P, Bujdakova J.  Short-term prognosis of stroke due to occlusion of internal carotid artery based on transcranial Doppler ultrasound . Stroke . 1992;;23:1069-1072.
16 +
Schneider PA, Rossman MA, Bernstein EF, et al.  Noninvasive assessment of cerebral collateral blood supply through the ophthalmic artery . Stroke . 1991;;22:31-36.
17 +
Brass LM, Duterte DL, Mohr JP.  Anterior cerebral artery velocity changes in disease of the middle cerebral artery stem . Stroke . 1989;;20: 1737-1740.
18 +
Karnik R, Stelzer P, Slany J.  Transcranial Doppler sonography monitoring of local intra-arterial thrombolysis in acute occlusion of the middle cerebral artery . Stroke . 1992;;23:284-287.
19 +
Mull M, Aulich A, Hennerici M.  Transcranial Doppler ultrasonography versus arteriography for assessment of the vertebrobasilar circulation . J Clin Ultrasound . 1990;;18:539-549.
20 +
Droste DW, Harders AG, Rastogi E.  A transcranial Doppler study of blood flow velocity in the middle cerebral arteries performed at rest and during mental activities . Stroke . 1989;;20:1005-1011.
21 +
Kelly RE, Chang JY, Scheinman NJ, et al.  Transcranial Doppler assessment of cerebral flow velocity during cognitive tasks . Stroke . 1992;;23: 9-14.
22 +
Thie A, Fuhlendorf A, Spitzer K, Kunze K.  Transcranial Doppler evaluation of common and classic migraine, II: ultrasonic features during attacks . Headache . 1990;;30:209-215.
23 +
Caekebeke JFV, Ferrari MD, Zwetsloot CP, et al.  Antimigraine drug sumatriptan increases blood flow velocity in large cerebral arteries during migraine attacks . Neurology . 1992;;32:1522-1526.
24 +
Adams RJ, Nichols FT, Figueroa R, et al.  Transcranial Doppler correlation with cerebral angiography in sickle cell disease . Stroke . 1992;;23: 1073-1077.
25 +
Petty GW, Mohr JP, Pedley TA, et al.  The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation . Neurology . 1989;; 40:300-303.
26 +
Spencer MP, Thomas Gl, Nicholls SC, Sauvage LR.  Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography . Stroke . 1990;;21: 415-423.
27 +
Russell D, Madden KP, Clark WM, Sandset PM, Zivin JA.  Detection of arterial emboli using Doppler ultrasound in rabbits . Stroke . 1991;:22:253-258.
28 +
Teague SM, Sharma MK.  Detection of paradoxical cerebral echo contrast embolization by transcranial Doppler ultrasound . Stroke . 1991;;22: 740-745.
29 +
Padayachee TS, Parsons S, Theobold R, et al.  The detection of microemboli in the middle cerebral artery during cardiopulmonary bypass: a transcranial Doppler ultrasound investigation using membrane and bubble oxygenators . Ann Thorac Surg . 1987;;44:298-302.
30 +
Markus H, Loh A, Israel D, et al.  Microscopic air embolism during cerebral angiography and strategies for its avoidance . Lancet . 1993;;341: 784-787.
31 +
Bogdahn U, Becker G, Winkler J, et al.  Transcranial color-coded real-time sonography in adults . Stroke . 1990;;21:1680-1688.
32 +
Ackerstaff RGA, Keunen RMW, van Pelt W, et al.  Influence of biological factors on changes in mean cerebral blood flow velocity in normal ageing: a transcranial Doppler study . Neurol Res . 1990;;12:187-191.
33 +
Kontos HA.  Validity of cerebral arterial blood flow calculations from velocity measurements . Stroke . 1989;;20:1-3.
34 +
Polak JF, Dobkin GR, O'Leary DH, et al.  Internal carotid artery stenosis: accuracy and reproducibility of color Doppler-assisted duplex imaging . Radiology . 1989;;173:793-798.

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