1. Neurosonology in acute stroke patients
Školoudík D.
Department of Neurology
University Hospital Ostrava & Olomouc
Good afternoon Ladies and gentleman I want to present our first experience of the evaluation of SN in PD and atypical PS

2. Neurosonology Duplex sonography of cervical arteries
Duplex sonography of eyehole (ophthalmic artery, optical nerve)
Transcranial Doppler
Transcranial duplex sonography

3. Methodology
Necessity of fast diagnostic – occlusion or stenosis of cervical or intracranial artery for a choosing the best therapeutical method
Examination must not exceed 5 – 10 minutes
Echocontrast agent use

4. Carotids
Stenosis
Occlusion
Dissection
Arteriitis

5. Evaluation of stenosis
PSV – best correlation with DSA (sensitivity, specificity approx. 90%)
EDV
PSV ICA/PSV CCA, EDV ICA/EDV CCA
Lumen reduction, area
Calcification!!!

6. Chronic vs. acute occlusion
B-mode (anechogenic acute thrombus)
Collateral flow
Asymmetric PSV in MCA´s

11. Vertebral arteries
Stenosis
Occlusion
Steal syndom
Dissection

15. Eyehole

18. TCCS/TCD 1-4/2 MHz probe, (MI 1.5, TIS 1.2)
TCCS: B-mode, M-mode, color mode, power mode, Doppler mode
TCD: Doppler mode, Power M-mode
Acoustic window - temporal, suboccipital, frontal, occipital, orbital, submandibular

19. Acute stroke Occlusion of intracranial stenosis
Intracranial artery stenosis
Hemodynamic changes (e.g. ICA occlusion)
HITS / MES
Haemorhage
Angiopathy
Intracranial hypertension

23. Artery occlusion
Main: B-mode (MCA), Doppler mode (no flow in occlusion, low PSV and high PI, RI proximaly to the occlusion)
Other: color mode, power mode, detection of collaterals

26. Occlusion of MCA branches
Asymmetry in PSV (Zanette index 1.3, 30% site-to-site difference, TIBI criteria)
Increase of PI a RI

27. Artery stenosis - dg. criteria
Main: local jet with PSV ratio more than 1.5
Other: turbulent flow, aliasing in color mode, lumen narrowing in power mode

28. stenosis poststenotic•
PSV-S/PSV-Z = 267.1/70.4 = 3.78 …
grade III

29. Grading of stenosis US AG Grade I: PSV index 1.5-1.99 … 20-39%
Grade II: PSV index … %
Grade III: PSV index > = … >= 60%
Correlation:
kappa coefficient: 0.68

32. Angiopathy

33. Haemorrhage

35. Increasing of intracranial pressure

36. Thrombosis of cerebral sinuses

37. Limitation Dependence on sonographer experience
Insufficient bone window (8 – 20%)

38. %
age (years)
female
male

39. Echocontrast agents
Bolus injection ml Optison (1:10) nebo 0.5ml SonoVue
Blooming!
Increasing of a Doppler signal for about 1 minute

40. Monitoring Monitoring HITS / MES Monitoring of artery recanalization
Sonothrombotripsy, sonothrombolysis

41. Microembolus

42. Microembolus

47. Thanks
for your
attention