transcranial Doppler ultrasonography

Transcranial Doppler Ultrasonography

 

Definition

Transcranial Doppler ultrasonography is a noninvasive method of analyzing blood flow in the brain.

Purpose

The blood that flows through the brain distributes nutrients to the brain and removes wastes. This flow maintains the high rate of metabolism necessary for the brain to function. Restrictions in blood flow may occur from vessel narrowing (stenosis), clot formation (thrombosis), blockage (embolism), or blood vessel rupture (hemorrhage). Lack of sufficient blood flow (ischemia) threatens brain tissue and may cause a stroke.
The flow of blood through the arteries in the brain can be analyzed using transcranial Doppler ultrasonography (TCD). TCD is a form of ultrasound, in which high frequency sound waves bounce off or pass through body tissues. While most other types of ultrasonography create images of the tissue being studied, the results of TCD are audible sounds that the examiner listens to and records.
Doppler ultrasonography uses what is called the Doppler effect to measure the rate and direction of blood flow in the vessels. Just as a siren's pitch sounds higher when its source is moving toward you and lower as it moves away, so too will ultrasound waves change pitch, or frequency, as they bounce off the red blood cells moving in the blood. It is these pitch changes that produce the audible sounds during the exam.
Changes in frequency can be used to measure both the direction and the speed of blood flow. Faster blood flow causes a greater change in frequency. Combined with other tests, this information can be used to locate restrictions in the blood vessels in the brain, and to track changes in blood flow over time. In this way, TCD gives valuable information about the site of a stroke and the patient's progress after a stroke. TCD is also used to evaluate the contraction of blood vessels that can occur if a blood vessel ruptures.

Precautions

Ultrasonography procedures are safe, noninvasive, and painless. No special precautions are necessary.

Description

TCD is done with either one or two probes placed against the skin. The examiner spreads a clear gel on the areas of the head where the probe will be placed. Usually, the probes are placed on the temple, on the base of the skull at the back of the neck, and over the closed eyelid. In these places, there is the least amount of thick protective bone and the sound waves can penetrate the best. The examiner adjusts the probe position and orientation to direct the sound waves toward the blood vessels of interest. Finding the best approach may take some time. A compression test may be performed during the exam. In this test, the main artery in the neck (carotid artery) is briefly compressed, and changes in blood flow patterns are observed. A full TCD exam may last 30-45 minutes, and often longer in patients with disease.

Preparation

No special preparation is needed. The patient should remove contact lenses, and may wish to avoid the use of eye makeup, since the gel is likely to smear it.

Aftercare

The gel is washed off with soap and water. No other after care is needed.

Risks

TCD is noninvasive and has no risks. A compression test is occasionally, though very rarely, hazardous for a patient with narrowed arteries (atherosclerosis), since the increased pressure may dislodge a piece of the substance that causes the narrowing (plaque).

Normal results

TCD produces an audible sound that varies with the heartbeat. It also varies depending on the direction and rate of flow through the vessel being examined. Each of the vessels in the brain has a characteristic direction of flow, which can be detected by TCD. Flow rates are somewhat variable from person to person.

Abnormal results

Lack of flow indicates a vessel has been completely blocked (although absence of a signal may also be due to absorption of sound waves by bone). If blood flows in the wrong direction or alternates between normal and reverse flow, it may mean there is a blockage elsewhere. This happens because blood is rerouted due to abnormalities in pressure caused by the blockage.
If the speed of flow is increased, it may mean that blood is flowing through a restricted area that is just "upstream" from the probe. Intuitively, one might think that a restricted blood vessel would cause the speed of blood flow to slow down. However, the opposite is true. This is because the same amount of blood going through a narrower opening must go faster. Increased speed is also seen if a vessel is carrying rerouted blood.

Resources

Books

Samuels, Martin, and Steven Feske, editors. Office Practice of Neurology. New York: Churchill Livingstone, 1996.

transcranial Doppler ultrasonography

a form of Doppler ultrasonography in which pulses of ultrasound are directed at vascular formations in the base of the skull, allowing measurements of blood flow velocity in the major basal intracranial arteries on a real-time basis.

transcranial Doppler ultrasonography

A non-invasive modality of bedside imaging of the intracranial cerebral circulation in critically ill hospitalized Pts and outpatients, used to diagnose vasospasm, assess collateral circulation and stenoses, to confirm brain death and monitor circulation in neurosurgical Pts

transcranial Doppler ultrasonography

Ultrasonography, using the DOPPLER EFFECT, to investigate the blood flow in the arteries supplying the brain with blood. This allows monitoring during neurosurgery and the detection of abnormal arterial narrowing or of dangerous arterial spasm after subarachnoid haemorrhage. The method has been used to investigate mood disorders and has identified abnormalities in the limbic system in severe depression.
References in periodicals archive ?
The machine known as Transcranial Doppler Ultrasonography (TCD), costs AED 260,000 and is known to be help prevention of stroke in patients with sickle cells by detecting the probability early on.
Over an eight-year period, researchers found that the technique, transcranial Doppler ultrasonography (TCD), along with regular transfusions for children found to be at high risk, reduced stroke to one-tenth of the incidence found before TCD was introduced.
Transcranial Doppler ultrasonography can provide important information for managing patients with cerebrovascular disease, but the clinical utility of such imaging is uncertain for most indications, a review of published data has shown.

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