Bathala Lokesh, Mehndiratta Man Mohan, Sharma Vijay K
Department of Neurology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India.
Ann Indian Acad Neurol. 2013 Jan;16(1):121-7. doi: 10.4103/0972-2327.107723.
Although the clinical features in some patients with cerebrovascular ischemia may be ill defined, majority of the patients present with focal neurological deficits caused by an arterial occlusion, and the clinical presentations are usually referable to the involved arterial territory. Therefore, vascular imaging constitutes an important component of the diagnostic workup. Cervical duplex ultrasonography of carotid and vertebral arteries is employed to evaluate the extracranial vasculature while transcranial Doppler provides important information about intracranial hemodynamic changes in cerebrovascular ischemia. These two components of cerebrovascular ultrasonography are fast and reproducible, and can be performed at the bedside. They provide real-time information about the status of cervico-cranial arterial patency and various hemodynamic alterations, including collateral flow. The information obtained from cerebrovascular ultrasonography is useful for diagnostic as well as prognostic purposes. Furthermore, it can be used to monitor cerebral blood flow for extended periods and aid in decision making for various interventions. The hemodynamic information obtained from cerebrovascular ultrasonography helps in determining the underlying mechanisms of brain ischemia, and is complementary to the clinical examination and other imaging modalities.We describe the technique of performing cervical duplex sonography, diagnostic criteria for arterial stenosis, characterizing plaque morphology, measuring intima-media thickness and various pitfalls while performing the test.
尽管一些脑血管缺血患者的临床特征可能不明确，但大多数患者表现为由动脉闭塞引起的局灶性神经功能缺损，且临床表现通常与受累动脉区域相关。因此，血管成像构成了诊断检查的重要组成部分。颈动脉和椎动脉的颈部双功超声检查用于评估颅外血管系统，而经颅多普勒可为脑血管缺血时的颅内血流动力学变化提供重要信息。脑血管超声检查的这两个组成部分快速且可重复，并且可以在床边进行。它们提供有关颈颅动脉通畅状态和各种血流动力学改变（包括侧支血流）的实时信息。从脑血管超声检查获得的信息对诊断和预后都很有用。此外，它可用于长时间监测脑血流量，并有助于各种干预措施的决策。从脑血管超声检查获得的血流动力学信息有助于确定脑缺血的潜在机制，并且是对临床检查和其他成像方式的补充。我们描述了进行颈部双功超声检查的技术、动脉狭窄的诊断标准、斑块形态的特征描述、内膜中层厚度的测量以及检查过程中的各种陷阱。
