Gorman Mark J, Nyström Karin, Carbonella Judith, Pearson Howard
Stroke Program, Department of Neurology, University of Vermont, Given C219D, 89 Beaumont Avenue, Burlington, VT 05405-0068, USA.
Neurology. 2009 Aug 4;73(5):362-5. doi: 10.1212/WNL.0b013e3181ae2361. Epub 2009 Jun 24.
Transcranial Doppler (TCD) ultrasound is a procedure commonly used to screen individuals with the major hemoglobin S diseases, Hb SS and Hb S-beta(0), for significant stenoses in the circle of Willis. Flow velocities above 200 cm/s have been shown to identify patients at elevated risk for cerebral infarction. Among TCD's limitations is the inability to insonate the distal extracranial, petrous, and cavernous internal carotid artery (ICA) through the standard transtemporal approach.
We extended the submandibular approach to include infra-siphon portions of the ICA.
Using the extended submandibular approach to evaluate these portions of the ICA, we identified stenotic lesions in 4 patients with Hb SS disease out of a population of 131 children with Hb SS. Three of the 4 patients had no history of overt stroke or stroke-like symptoms. Neuroimaging confirmed the stenotic lesions, and also revealed watershed infarction as well as discrete areas of silent infarction. All 4 children had neuropsychological impairment.
The submandibular approach, when added to a standard transcranial Doppler examination, may increase the sensitivity of this technique to identify important potential sources of cerebral infarction.
经颅多普勒（TCD）超声是一种常用于筛查患有主要血红蛋白S病（Hb SS和Hb S-β(0)）的个体 Willis 环显著狭窄的检查方法。已证明血流速度高于200 cm/s可识别脑梗死风险升高的患者。TCD的局限性之一是无法通过标准颞部途径探测到颅外远端、岩骨段和海绵窦段颈内动脉（ICA）。
我们扩展了下颌下途径，以纳入ICA的虹吸部以下部分。
采用扩展的下颌下途径评估ICA的这些部分，在131例Hb SS病儿童中，我们在4例患者中发现了狭窄病变。这4例患者中有3例无明显中风或中风样症状史。神经影像学证实了狭窄病变，还发现了分水岭梗死以及散在的无症状性梗死区域。所有4名儿童均有神经心理学损害。
将下颌下途径添加到标准经颅多普勒检查中，可能会提高该技术识别脑梗死重要潜在来源的敏感性。
