59例不同年龄段偏头痛患者经颅多普勒超声探测脑血流变化的临床意义

目的 探讨经颅多普勒超声(TCD)对偏头痛的检测价值.方法 59例偏头痛患者,按不同年龄段分成5组,在急性发作期应用TCD检测血流速度.结果 偏头痛患者不同年龄段急性发作期脑血流速度和正常人血流速度与同名动脉比较,偏头痛患者和正常人血流速度差异有统计学意义(P<0.01).结论 TCD可敏感而准确地反映偏头痛患者在急性...     

Transcranial color Doppler sonography on healthy pre-school children: flow velocities and total cerebral blood flow volume

Transcranial color Doppler sonography (TCCD) is a useful tool for intracranial investigation. Using TCCD to calculate total cerebral blood flow volume (TCBFV) can be a useful indicator for intracranial hemodynamic status. We performed a series study of TCCD on 60 healthy kindergarten students. Peak-systolic, end-diastolic, and mean blood velocities of major cerebral arteries, and depth of flow waves were measured. We also collected Gosling pulsatile index (PI) and Pourcelot resistance index (RI) of the arteries. TCBFV was calculated from the mean blood flood velocity and vessel chamber size of the internal carotid artery (ICA) and basilar artery (BA). Fifty children completed the examinations. The TCBFV was 1538+/-416 ml/min with mean cerebral blood flow volume of 571+/-241 ml/min for the ICA system and 983+/-343 ml/min for the BA system. PI, RI, and the velocities of A1, A2, M1, M2, BA, ICA, and TCBFV were not significantly different between girls and boys in this age group. In this study, we used TCCD to determine the normal data of main cerebral arteries and TCBFV of pre-school children in Taiwan. The reference data of velocities and other parameters of main cerebral arteries from our study may serve as a guide for additional pediatric cerebral hemodynamic studies.     

Transcranial Doppler sonographic studies of cerebral autoregulation in Shy-Drager syndrome

Summary A study is reported of mean arterial blood pressure and heart rate in four patients suffering from Shy-Drager syndrome. Blood flow velocity in the middle cerebral artery (MCA) was recorded by transcranial Doppler sonography. Concomitant changes in cerebral blood flow and the effect of cerebral autoregulation were thus examined. During tilt (60°, head up) mean arterial blood pressure decreased by 40 mm Hg or 35%, while MCA blood flow velocity dropped by 14 cm/s or 28% (mean values). The lower percentage reduction in flow velocity may indicate a preserved cerebral autoregulation in central autonomic insufficiency.     

Emotionally evoked changes in cerebral hemodynamics measured by transcranial Doppler sonography

The cerebral representation of emotions has previously been investigated by the study of patients with local brain damage, experiments with selective stimulation of only one hemisphere, and more recently by imaging techniques such as positron-emission tomography or magnetic resonance imaging measuring local cerebral blood flow. We investigated the mean flow velocity (FV_mean) in the middle cerebral artery (MCA) by transcranial Doppler sonography during emotional stimulation with video scenes in 24 healthy test persons. The videos consisted of an erotic scene and a violent scene shown in contrast to a calming scene. Blood pressure, heart rate, and breathing frequency were monitored continuously by noninvasive measurement. FV_mean increased during the erotic scene to 108.5 ± 11.9% (P < 0.05) of the baseline value in the right MCA and to 109.0 ± 10.6% (n.s.) in the left MCA. During the violent scene FV_mean reached 109.0 ± 8.7% (P < 0.05) on the right side and 108.1 ± 13.0% (n.s.) on the left side. The FV_mean time course showed a close relationship to the video sequence. During scenes involving great tension FV_mean showed a plateaulike state and peaked during sudden actions. Blood pressure, heart rate, and respiratory rate showed no significant changes. However, we observed a tendency towards lower heart rates (lowest value 94.5 ± 13.6%) during the erotic scene and two peaks (103.2 ± 13.3%, 104.8 ± 16.8%) coinciding with sudden violent actions. The significant increase in FV_mean in the right MCA supports the theory of a right hemisphere dominance for the processing of emotions. Received: 12 March 1998 Received in revised form: 13 July 1998 Accepted: 24 July 1998     

Cerebral Hemodynamic Response to Generalized Spike-Wave Discharges

Summary: Purpose: Data in the literature concerning metabolic demand during generalized spike-wave activity (gSW) are conflicting. We investigated instantaneous changes in cerebral blood flow velocities (CBFV) in both middle cerebral arteries (MCAs) by transcranial Doppler sonography (TCD) during gSW paroxysms recorded by scalp EEG.
Methods: In 13 patients, CBFVs in both MCAs were averaged, time-locked to the occurrence of the gSW; respiratory rate (RR) and end-expiratory pco, were measured in one patient.
Results: Nine patients showed significant changes in CBFV during gSW. Four had biphasic flow changes with an initial increase (p < 0.05) and a subsequent decrease (p < 0.01). This was partially paralleled by an increase in RR (p < 0.01) and a decrease in pco, (p < 0.01). In three patients, an increase in CBFV that preceded the onset of gSW by several seconds was observed, followed by a decrease in CBFV. Two patients showed a significant decrease only of CBFV. Only gSWs of a median duration of >0.8 s were associated with significant changes in CBFV.
Conclusions: We were able to demonstrate that gSWs of several seconds duration lead to cortical perfusion changes. We suggest that the initial increase of CBFV demonstrated in some patients reflects neuronal activation, whereas the subsequent decrease might in part be due to hyperventilation-induced hy-pocapnia.     

Demonstration of giant MCA aneurysm by transcranial duplex sonography and color Doppler imaging

Transcranial color Doppler sonography is a new diagnostic technique which allows real-time, colorcoded imaging of basal cerebral arteries, with simultaneous demonstration of parenchymal structures in the B-mode scan. With this technique we were able nonivasively to show a giant fusiform aneurysm of the middle cerebral artery (MCA) in an 11-year-old boy. Transcranial color Doppler sonography through the intact temporal bone demonstrated the size and location of the aneurysm and provided real-time imaging of the pulsating intra-aneurysmal flow. Additionally, duplex sonographic measurements of intravascular flow velocities within the aneurysm and the feeding and draining artery were possible. Postoperatively, patency of the MCA with reduced flow velocities after excision of the aneurysm could be shown. This is the first transcranial color Doppler report in a patient with an intracerebral aneurysm. In our opinion, transcranial color Doppler sonography offers new diagnostic possibilities in patients with cerebrovascular disorders.     

晚发型帕金森病经颅超声的表现

目的 研究晚发型帕金森病(LOPD)患者经颅超声(transcranial sonography,TCS)的表现.方法 招募符合入选标准的LOPD患者和年龄匹配的正常对照者,分别进行TCS检测.对于检测成功的受试者的黑质异常信号进行半定量分级测评,同时测定第三脑室的宽度.结果 TCS检查在老年女性中成功率很低.两组间黑质强回声分级有极强的显著性差异.黑质强回声分级与患者的年龄、发病年龄、病程及病情严重程度不相关.两组间第三脑室宽度无显著性差异.结论 TCS检查在老年女性中应用受限制.明显的黑质异常强回声可能是LOPD患者的特征性表现.其强回声分级与患者年龄、发病年龄、病程及病情严重程度不相关.晚发型帕金森病患者组无明显第三脑室增宽.

Abstract：

Objective To investigate the characteristic features of transcranial sonography (TCS) in patients with late-onset Parkinson' s disease (LOPD). Methods We enlisted some LOPD patients and age-matched normal controls according to special criteria, and detected them by TCS. The obtained images of the subjects whose images could offer analyzing substantia nigra (SN) hyperechogenicity with sufficient resolution were evaluated. We used semi-qualitative estimation criteria to assess SN hyperechogenicity and also measured the widths of the third ventricles. Results There was a high rate of recording failure of the SN in older females. Significant SN hypereehogenicity was observed in LOPD patients group.There was no correlation between the degree of SN hyperechogenicity and patients' age, onset age, duration of illness, and the severity of condition. There was no significant difference of the widths of the third ventricles between groups. Condusions The recording failure in aged females may limit the clinical potential of TCS. SN hyperechogenicity maybe the characteristic features in LOPD patients. There was no correlation between the degree of SN hyperechogenicity and patients'age,onset age, duration of illness, and the severity of condition. The widths of the third ventricles in LOPD patients group were not increased significantly.     

Transcranial Doppler monitoring of cerebral embolism in atrial fibrillation and prosthetic valves. Clinical correlations

Transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA) permits the detection of high intensity transient signals (HITS), which are believed to represent microemboli. Non-valvular atrial fibrillation (NVAF) and prosthetic heart valves (PV) are important risk factors for embolic stroke. We evaluated both the prevalence and the frequency of microemboli in these high risk groups and the correlation with previous stroke. Sixty-six patients were monitored for 30 min on both MCAs sequentially. Twenty healthy subjects were studied as well. The total number of HITS recorded on both sides, expressed as HITS/h, was used for comparison. In NVAF patients (n = 24) the prevalence of HITS was 25%, in PV (n = 16) 62% and in those patients in whom PV coexisted with atrial fibrillation (PVAF) (n = 26), it was 42%. None in the control group showed HITS. HITS occurred significantly more frequently in PVAF (12.3/h) than in both NVAF (1.4/h, p = 0.007) and PV (2.7/h, p = 0.011), whereas there was no difference between PV and NVAF. The prevalence of HITS was not statistically different in patients with and without previous stroke, but among HITS positive patients those with previous stroke had a significantly higher HITS frequency (18.9 vs 8.5/h, p = 0.04). In conclusion, in patients with cardiac embolic sources the frequency of HITS increases from the classes with the lower (NVAF, PV) to the class with the highest (PVAF) risk factor. Patients with previous stroke have more HITS than asymptomatic ones. Therefore, embolus detection monitoring seems a promising tool in the assessment of the individual stroke risk in patients with cardiac embolic sources.     

Cerebral hemodynamic response induced by the Tower of Hanoi puzzle and the Wisconsin Card Sorting test

Transcranial Doppler sonography (TCD) was applied in normal subjects to investigate the effect of prefrontal functions like the Tower of Hanoi (TOH) task and the Wisconsin Card Sorting test (WCST) on cerebral hemodynamics. In 20 healthy volunteers, left and right middle cerebral artery (MCA) and anterior cerebral artery (ACA) were insonated. The TOH task and the WCST were administered while cerebral blood flow velocity (CBFV) was registered. Each test was repeated once per artery pair. There was a visuomotor test to control the motor and visual stimulations. Three phases of CBFV time course were detected: an initial peak within 5 s, a following decrease within 25 s and a steady state beginning at 40 s. The TOH task, WCST and visuomotor tests had different mean CBFV during the initial peak (MCA: P<0.05; ACA: P<0.05) as well as for the decrease (ACA: P<0.01) and the steady state (MCA: P<0.01; ACA: P<0.01). The TOH showed an increased mean CBFV as compared with the WCST during the steady state (MCA: P<0.01; ACA: P<0.05). However, temporal modulation of mean CBFV during category shift of the WCST resulted in significantly increased values after category shift (MCA: P<0.001; ACA: P<0.01) as compared with CBFV before the category shift. These findings showed a different CBFV pattern during the TOH task and WCST than during the visuomotor test. In conclusion, TCD was able to assess CBFV in prefrontal functions, using a high resolution in time.     

Assessment of blood flow velocities in the ophthalmic arteries by transcranial Doppler sonography in osteopetrosis

Osteopetrosis is a rare congenital disorder of bone resorption, which causes generalized hyperostosis. One of its many complications involves the skull base and progressive encroachment of the optic nerves within their canals, resulting in optic atrophy and blindness. Management of patients with deteriorating vision may include surgical decompression of the optic canals; their selection requires careful assessment by radiology, computed tomography, visual evoked potentials, electroretinography and possibly hæmodynamic studies of the ophthalmic arteries. Postoperative changes can create difficulty in the interpretation of follow-up radiological investigations. In this study, transcranial Doppler sonography was used to assess the blood flow velocities in the ophthalmic arteries non-invasively. Pre- and postoperative studies of the Doppler parameters were done for each ophthalmic artery in a 5-month-old boy under standard physiological conditions. He presented with almost complete blindness and subsequently showed a good outcome following surgical intervention.     

Continual Transcranial Doppler in the Monitoring of Hemodynamic Change following Aneurysmal Subarachnoid Hemorrhage

Aims: To analyze and compare the value of different treatment methods for acute aneurysmal subarachnoid hemorrhage (aSAH)‐related vasospasm. Cerebral hemodynamic variables’ changes were evaluated by transcranial Doppler (TCD) in aSAH patients within 14 days after onset. Methods: Thirty aSAH patients were enrolled in the study within 72 h after onset. Baseline CT and TCD were used for assessment. Patients were divided into three groups according to SAH severity and patients’ discretion: nonsurgical group, endovascular coiling, and neurosurgical clipping. TCD hemodynamic parameters were measured and Lindegaard index was calculated daily from onset to 14th day after SAH. The group mean cerebral blood velocity (MBFV) and Lindegaard index were compared using repeated measures analysis of variance (reANOVA). Least Significant Difference (LSD) test was used for post hoc comparison. All 30 patients were followed for 90 days after onset for outcome assessment. Results: The values of MBFV and Lindegaard index of anterior cerebral artery (ACA)/middle cerebral artery (MCA) from high to low is nonsurgical group, clipping and coiling (ACA: P= 0.0001/P= 0.006; MCA: P= 0.243/P= 0.317). Conclusions: These results indicate that both neurosurgical clipping and endovascular coiling management may relieve the severity of cerebral vasospasm in acute aSAH.     

多普勒超声对脑静脉系统血栓形成的诊断价值

多普勒超声在颅内外动脉系统疾病中的诊断价值已受到临床医生的一致认可,但在脑静 脉系统的应用却一直未受到足够的重视。脑静脉血栓形成（cerebral venous thrombosis,CVT）发病率 较低,诊断主要依靠磁共振静脉血管成像及数字减影血管造影,然而这些形态学检查不能为临床提 供血流动力学信息。多普勒超声能够对脑静脉系统血流动力学进行检测,为CVT的诊断、治疗及预后 提供丰富的信息,本文将多普勒超声在颅内静脉中的应用进行综述,旨在提高超声医生及临床医生 对超声在颅内静脉血流动力学的评估作用的认识。     

Predictability of intracranial pressure oscillations in patients with suspected normal pressure hydrocephalus by transcranial Doppler ultrasound

Abstract

Intracranial pressure (ICP) was monitored continuously for one night in 36 patients with suspected symptomatic normal pressure hydrocephalus (NPH) to identify patients who might benefit from subsequent shunting. In 33 of these patients middle cerebral artery (MCA) blood flow velocity by means of transcranial Doppler sonography (TCD) and ICP were recorded simultaneously. ICP B-waves always paralleled changes in the TCD signal (TCD B-wave equivalents). The relative frequency of ICP B-waves was predictable by TCD, albeit slightly underestimated due to a generally lower relative amplitude of the TCD B-wave equivalents. However; the same TCD B-wave equivalent amplitude could be accompanied by quite different ICP changes in different patients. Considering the baseline values in the absence of pressure wavesthere was no significant relationship between ICP and TCD resistance index (Pourcelot) in different patients. Raising ICP by injection of 10 ml saline into the ventricle, however was accompanied by an increased TCD resistance index in the individual patient. As the relative frequency of B-wave activity is assumed to be an indicator for shunt responsiveness, continuous TCD monitoring can be used as a screening procedure to detect the presence and the relative frequency of B-wave activity in patients with suspected NPH. However, since neither the absolute ICP nor the amplitude of spontaneous oscillations can be predicted, TCD monitoring is not suitable to replace ICP monitoring. [Neurol Res 1994; 16: 398-402]     

TCD对普通和典型偏头痛患者间歇期血管机能状态的研究

采用经颅多普勒超声（ＴＣＤ）技术，对１３０例普通和典型偏头病人头痛间歇期的超声表现进行了研究。结果表明：普通和典型偏头痛之间ＴＣＤ改变性显著性差异。提示两种类型偏头痛于头痛间歇期血管机能的改变相同；偏头痛病人颅内动脉的平均血流速度（ＭＦＶ）均明显高于正常对照组，反映头痛间歇期病人的颅内动脉处于广泛的收缩状态而不伴颅外动脉的明显改变。     

原发性脑出血急性期经颅多普勒血流参数变化规律

目的 探讨原发性脑出血（spontaneous intracerebral hemorrhage,ICH）急性期经颅多普勒（transcranialdoppler,TCD）超声血流参数变化规律及与30d死亡的相关性。方法 前瞻性入组87例首次发病24h以内,原发幕上脑出血患者。按照出血量分为小量出血组（n=21）、中量出血组（n=27）和大量出血组（n=39）。入组患者发病24h内行颅脑计算机断层扫描（computed tomography,CT）检查。于发病24h内、第3、7、14d行床旁TCD监测,记录双侧大脑中动脉收缩期峰值血流速度（systolic velocities,Vs）、舒张期血流速度（diastolic velocities,Vd）、平均血流速度（mean velocities,Vm）、搏动指数（pulsatility index,PI）、阻力指数（resistive index,RI）。其中48例患者完成全部TCD监测。对各组血流动力学参数进行比较。结果 发病24h以内,小量出血组血流动力学参数接近正常值;中量、大量出血组健侧Vm降低（P <0.01）,双侧Vd降低（患侧：P＜0.01;健侧P＜0.01）,双侧PI、R（I 患侧：P =0.001;健侧：P＜0.01）升高,大量出血组较中量出血组变化明显。脑出血发病14d以内双侧Vm值呈持续下降趋势。30d死亡患者健侧Vd比存活患者显著降低（P <0.01）,双侧PI,RI升高（P＜0.01）。结论 TCD血流参数的变化可以反映脑出血急性期颅内血流变化规律,是评估预后的重要指标。     

237例脑动静脉畸形的彩色经颅多普勒超声检测与DSA比较分析

目的探讨彩色经颅多普勒超声无创诊断脑动静脉畸形（AVM）的临床应用价值。方法采用Acuson Sequoia512型彩色多普勒超声诊断仪,电子相控阵变频探头,使用频率2.0MHz,经颞窗、枕窗探测颅底主要血管及部分分支血管,了解各血管血流动力学改变以及AVM大小、部位、供血分支、引流静脉及颅内盗血情况,并与DSA检查结果进行比较分析。结果237例中除18例因透声窗不满意检测失败外,实际检测219例,其中明确诊断176例,可疑25例,未见明显异常18例,与DSA比较其总检出率为92%。结论彩色经颅多普勒超声能实时、动态观察畸形血管团及供血动脉血流动力学改变,了解引流静脉及颅内盗血情况,准确提供颅内血流动力学参数,因而可作为脑AVM诊断、疗效评估及随访的一种无创性检查手段。     

床旁TCD监测对蛛网膜下腔出血后迟发性脑缺血价值研究

目的 探讨床旁经颅多普勒超声（transcranial Doppler,TCD）监测在蛛网膜下腔出血（subarachnoid hemorrhage,SAH）后预测和发现脑血管痉挛,减少迟发性脑缺血（delayed cerebral ischemia,DCI）发生 的价值。 方法 连续纳入2011年10月至2013年10月首都医科大学附属北京天坛医院神内重症监护病房 （intensive care unit,ICU）住院的完成床旁TCD监测的222例SAH患者。记录患者的临床及影像资料、治 疗及并发症。入院24小时内完成TCD基线监测,根据结果分成正常组85例、流速增快组14例、血 管痉挛组123例,比较患者抗血管痉挛强化治疗的使用率、DCI及不良预后［3个月后改良Rankin量表 （modified Rankin Scale,mRS）评分4～6分］的发生率和治疗改善率的差异。 结果 3组患者比较,血管痉挛组和血流增快组的GCS评分低、Hunt-Hess分级Ⅰ～Ⅲ级比例少、世界 神经外科医师联盟（World Federation of Neurosurgical Society,WFNS）分级Ⅰ～Ⅲ级比例少、改良Fisher 分级3～4级所占比例多、颅内血肿发生率多,差异均具有显著性（P <0.05）。血管痉挛组和流速增快 组患者DCI 发生率高于正常组（68.2%、35.7%、3.2%,P＜0.01）。TCD流速增快组和血管痉挛组患者给 予的抗血管痉挛加强治疗（70.6%、100%、4.1%）及脑脊液置换治疗（21.2%、7.1%、5.7%）多,临床缓 解率（56.5%、28.6%、10.6%）高（P＜0.01）。90天随访血管痉挛组和流速增快组预后不良高于正常组 （30.6%、21.4%、15.4%,P =0.031）。 结论 TCD结果异常的患者（血管痉挛组和血流增快组）发病后的病情重,出血量大,尽管给予加强 治疗,DCI的发生率及预后不良率仍高于正常组。床旁TCD监测能够筛查出DCI高危患者并评价治疗效 果,是防治DCI所需的有效检测工具。     

TCD对颈内动脉中度及重度狭窄患者脑血流动力学的评估价值

目的应用经颅多普勒超声(transcranial doppler,TCD)评价颈内动脉中度及重度狭窄患者的脑血流动力学变化。方法经数字减影血管造影(digital subtraction angiography,DSA)确诊单侧颈内动脉中度及重度狭窄的患者69例,采用TCD检测其大脑中动脉血流参数,评价其侧支循环开放情况和脑血流储备能力(CRV)。结果 TCD显示侧支循环开放者患侧收缩期峰时血流速度(Vs)、搏动指数(PI)及CVR明显高于无侧支循环开放患者(P0.05),颈内动脉中度狭窄组患侧收缩期峰时血流速度(Vs)、PI值及CVR明显高于重度组(P0.05)。结论颈内动脉狭窄时侧支开放可以改善远端血流动力学指标,但改善程度有限。TCD可检测颈内动脉狭窄患者颅内血流动力学变化,评价颅内侧支循环的建立情况,为临床治疗和评估提供可靠依据。     

帕金森病患者经颅脑实质超声所见与临床评价

目的探讨经颅脑实质超声中发现的中脑黑质高回声与帕金森病(PD)的关系。方法连续入选2010~2013年中日友好医院门诊和住院诊断的123例PD患者及78例健康对照者,行经颅脑实质超声检查,测量黑质区域强度Ⅲ级的信号面积、第三脑室宽度及基底节区有无异常信号。并对123例PD患者进行统一帕金森病评定量表(UPDRS)评分、HoehnYahr分级。最后分析黑质高回声面积与UPDRS评分、HoehnYahr分级的相关性。结果最后入组89例PD患者及60例健康对照者。89例PD患者中,81例患者黑质高回声面积≥0.2 cm2;60例健康志愿者中,5例黑质高回声面积≥0.2 cm2。PD患者组的黑质高回声面积与健康对照组有明显差异。Pearson相关性分析发现黑质高回声面积的大小与患者发病年龄及病程长短无关系;较大侧黑质高回声与UPDRS评分的总分、第Ⅲ部分及HoehnYahr分级有明显相关性。黑质高回声面积在临床症状(UPDRSⅢ)较重的对侧较大。结论我国PD患者中脑黑质高回声是PD的一个特征性标记,其面积大小与PD患者运动症状的严重程度呈正相关,临床上可将经颅脑实质超声作为PD患者诊断的工具之一。