Abstract
Carotid dissections can cause neurological deficits either by hemodynamic or embolic mechanisms. Anticoagulants are often used in this setting to prevent neurological deterioration and stroke recurrence. High-intensity transient signals (HITS) detected by transcranial Doppler may be due to microembolism. We investigated the presence and number of HITS in a series of 27 patients with carotid dissection. HITS were detected in 14 (52%) patients and only in cases with a less than 7-day evolution. No association was found between HITS and clinical or imagiological features of the dissection nor with neurological aggravation or treatment type. We failed to demonstrate any relevant clinical significance of HITS in carotid dissection.
References
1.
Bogousslavsky J, Despland P-A, Regli F: Spontaneous carotid dissection with acute stroke. Arch Neurol 1987;44:137–140.
2.
Adams HP Jr, Butler MJ, Biller J, Toffol GJ: Nonhemorrhagic cerebral infarction in young adults. Arch Neurol 1986;43:793–796.
3.
Takis C, Saver J: Cervicocephalic carotid and vertebral artery dissection: Management, in Batjer H (ed): Cerebrovascular Disease. Philadelphia, Lippincott-Raven, 1997.
4.
Biousse V, D’Anglejan-Chatillon J, Touboul PJ, Amarenco P, Bousser MG: Time course of symptoms in extracranial carotid artery dissection. A series of 80 patients. Stroke 1995;26:235–239.
5.
Leys D, Lucas C, Gobert M, Deklunder G, Pruvo J-P: Cervical artery dissections. Eur Neurol 1997;37:3–12.
6.
Spencer MP, Thomas GI, Sauvage LR: Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography. Stroke 1990;21:415–423.
7.
Consensus Committee of the Ninth International Cerebral Hemodynamics Symposium: Basic identification criteria of Doppler microembolic signals. J Neuroimaging 1991;1:18–22.
8.
Batista P, Oliveira V, Ferro JM: The detection of microembolic signals in patients at risk of recurrent cardioembolic stroke: Possible therapeutic relevance. Cerebrovasc Dis 1999;9:314–319.
9.
Houser OW, Mokri B, Sundt TM, Baker HL, Reese DF: Spontaneous cervical cephalic arterial dissection and its residuum. Angiographic spectrum. AJNR 1984;5:27–37.
10.
Tong D, Albers G: Transcranial Doppler – Detected microemboli in patients with acute stroke. Stroke 1995;26:1588–1592.
11.
Ackerstaff RGA, Jansen C, Moll FL: Carotid endarterectomy and intraoperative emboli detection. Correlation of clinical, transcranial and magnetic resonance findings. Echocardiography 1996;13:543–550.
12.
Ries S, Schminke U, Dafferertshofer M, Schindlmayer C, Hennerici M: High intensity transient signals and carotid artery disease. Cerebrovasc Dis 1995;5:124–127.
13.
Sliwka U, Job FP, Wissuwa D, Diehl RR, Flachskamp FA, Hanrath P, Noth J: Occurrence of transcranial Doppler high intensity signals in patients with potential cardiac source of embolism. Stroke 1996;26:2067–2070.
14.
Daffertshofer M, Ries S, Schminke U, Hennerici M: High-intensity transient signals in patients with cerebral ischemia. Stroke 1996;27:1844–1849.
15.
Sliwka U, Lingnau A, Stohlmann W-D, Schmidt P, Mull M, Dihel R, Noth J: Prevalence and time course of microembolic signals in patients with acute stroke. Stroke 1997;28:358–363.
16.
Markus HS, Thomson N, Brown MM: Asymptomatic cerebral embolic signals in symptomatic and asymptomatic carotid artery disease. Brain 1995;118:1005–1011.
17.
Smith JL, Evans DH, Fan L, Bell PRF, Naylor AR: Differentiation between emboli and artefacts using dual-gated transcranial Doppler ultrasound. Ultrasound Med Biol 1996;22:1031–1036.
18.
Georgiadis D, Wnzel A, Zerkowski H, Zierz S, Linder A: Automated intraoperative detection of Doppler microembolic signals using bigate approach. Stroke 1998;28:137–139.
19.
Babikian V, Forteza A, Gavrilescu T, Samaraweera R: Cerebral microembolism and extracranial internal carotid artery dissection. J Ultrasonogr Med 1996;15:863–866.
20.
Scrinivasan J, Newell D, Sturzenegger M, Mayberg M, Winn HR: Transcranial Doppler in evaluation of internal carotid artery dissection. Stroke 1996;27:1226–1230.
21.
Goertler M, Baeumer M, Kross R, Blaser T, Lutze G, Jost S, Wallesch C-W: Rapid decline of cerebral microemboli of arterial origin after intravenous acetylsalicilic acid. Stroke 1999;30:66–69.
22.
Sitzer M, Siebler M, Steinmetz H: Silent emboli and their relation to clinical symptoms in extracranial carotid artery disease. Cerebrovasc Dis 1995;5:121–123.
23.
Wijman CAC, Babikian VL, Winter MR, Pochay VE: Distribution of cerebral microemboli in anterior and middle cerebral arteries. Acta Neurol Scand 2000;101:122–127.
24.
Censori B, Partziguian T, Camerlingo M, Mamoli A: Doppler microembolic signals predict ischemic recurrences in symptomatic carotid stenosis. Acta Neurol Scand 2000;101:327–331.
25.
Ringelstein EB, Droste DW: Monitoring for microembolic signals; in Babikian VL, Wechsler LR (eds): Transcranial Doppler Sonography, ed 2. Boston, Butterworth Heinemann, 1999, pp 157–166.
26.
Del Sette M, Angeli S, Stara I, Finocchi C, Gandolfo C: Microembolic signals with serial transcranial Doppler monitoring in acute focal ischemic deficit: A local phenomenon? Stroke 1997;28:358–363.
27.
Schievink W, Mokri B, Whisnant J: Internal carotid artery dissection in a community Rochester, Minnesota, 1987–1992. Stroke 1993;24:1678–1680.
28.
Leys D, Moulin TH, Stoijovic T, Begey S, Chavot D, Donald investigators: Follow-up of patients with history of cervical artery dissection. Cerebrovasc Dis 1995;5:43–49.
29.
Kroll MH, Hellums JD, McIntire RV, Schafer AI, Moake JL: Platelets and shear stress. Blood 1996;88:1525–1541.
30.
Segura T, Serena J, Teruel J, Dávalos A: Cerebral embolism in patient with polycythemia rubra vera. Eur J Neurol 2000;7:87–90.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.