Accurate assessment of stroke is critical for patient prognosis and selection of appropriate treatment regimens in order to optimize patient outcomes. Advanced neurosonologic techniques are straightforward, portable, and cost-effective, representing significant advantages over other noninvasive imaging modalities for monitoring of the hemodynamic status of acute ischemic stroke. Ultrasound findings acquired both early (<3 h from onset of stroke) and later (6–24 h after stroke) have demonstrated feasibility and validity for the detection of stenosis/occlusion of key intracranial structures, such as the middle cerebral artery, and for immediate and unambiguous indication of flow velocities, particularly when contrast enhancement is used. In addition, the target of thrombolysis can be identified and localized, and the success of therapy monitored, by transcranial ultrasound. Finally, transcranial ultrasound can be used to gauge the appropriateness of more complex and costly imaging studies, thereby optimizing utilization of health care resources.

Keywords:
Neurosonology, Acute stroke, Contrast-enhanced transcranial sonography
1.
Gerriets T, Goertler M, Stolz E, et al: Feasibility and validity of transcranial duplex sonography in patients with acute stroke. J Neurol Neurosurg Psychiatry 2002;73:17–20.
2.
Sekoranja L, Loulidi J, Yilmaz H, et al: Intravenous versus combined (intravenous and intra-arterial) thrombolysis in acute ischemic stroke: a transcranial color-coded duplex sonography – guided pilot study. Stroke 2006;37:1805–1809.
3.
Chimowitz MI, Kokkinos J, Strong J, et al: The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 1995;45:1488–1493.
4.
Feldmann E, Wilterdink JL, Kosinski A, et al: The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology 2007;68:2099–2106.
5.
Kaps M, von Reutern GM, Stolz E, von Buedingen H-J: Ultraschall in der Neurologie. Stuttgart, Thieme, 2005.
6.
Allendoerfer J, Goertler M, von Reutern GM: Prognostic relevance of ultra-early doppler sonography in acute ischaemic stroke: a prospective multicentre study. Lancet Neurol 2006;5:835–840.
7.
Alexandrov AV, Felberg RA, Demchuk AM, et al: Deterioration following spontaneous improvement: sonographic findings in patients with acutely resolving symptoms of cerebral ischemia. Stroke 2000;31:915–919.
8.
Baracchini C, Manara R, Ermani M, Meneghetti G: The quest for early predictors of stroke evolution: can TCD be a guiding light? Stroke 2000;31:2942–2947.
9.
Camerlingo M, Casto L, Censori B, Ferraro B, Gazzaniga GC, Mamoli A: Transcranial Doppler in acute ischemic stroke of the middle cerebral artery territories. Acta Neurol Scand 1993;88:108–111.
10.
Goertler M, Kross R, Baeumer M, et al: Diagnostic impact and prognostic relevance of early contrast-enhanced transcranial color-coded duplex sonography in acute stroke. Stroke 1998;29:955–962.
11.
Molina CA, Alexandrov AV, Demchuk AM, Saqqur M, Uchino K, Alvarez-Sabin J: Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke 2004;35:151–156.
12.
Schellinger PD, Thomalla G, Fiehler J, et al: MRI-based and CT-based thrombolytic therapy in acute stroke within and beyond established time windows: an analysis of 1,210 patients. Stroke 2007;38:2640–2645.
13.
Furlan A, Higashida R, Wechsler L, et al: Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282:2003–2011.
14.
Ogawa A, Mori E, Minematsu K, et al: Randomized trial of intraarterial infusion of urokinase within 6 h of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke 2007;38:2633–2639.
15.
Wunderlich MT, Goertler M, Postert T, et al: Recanalization after intravenous thrombolysis: does a recanalization time window exist? Neurology 2007;68:1364–1368.
16.
Neumann-Haefelin T, du Mesnil de RR, Fiebach JB, et al: Effect of incomplete (spontaneous and postthrombolytic) recanalization after middle cerebral artery occlusion: a magnetic resonance imaging study. Stroke 2004;35:109–114.
17.
Schellinger PD, Jansen O, Fiebach JB, et al: Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI. Stroke 2000;31:1318–1328.
18.
Chernyshev OY, Garami Z, Calleja S, et al: Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia. Stroke 2005;36:32–37.
19.
Ribo M, Molina CA, Rovira A, et al: Safety and efficacy of intravenous tissue plasminogen activator stroke treatment in the 3- to 6-hour window using multimodal transcranial Doppler/MRI selection protocol. Stroke 2005;36:602–606.
20.
Molina CA: Editorial comment – Degree of arterial recanalization: an end point for efficacy in future intravenous thrombolytic trials. Stroke 2004;35:114–115.
21.
Arnold M, Nedeltchev K, Brekenfeld C, et al: Outcome of acute stroke patients without visible occlusion on early arteriography. Stroke 2004;35:1135–1138.
22.
Rother J, Schellinger PD, Gass A, et al: Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke <6 h. Stroke 2002;33:2438–2445.
23.
Weimar C, Mieck T, Buchthal J, Ehrenfeld CE, Schmid E, Diener HC: Neurologic worsening during the acute phase of ischemic stroke. Arch Neurol 2005;62:393–397.
24.
Alexandrov AV, Burgin WS, Demchuk AM, El Mitwalli A, Grotta JC: Speed of intracranial clot lysis with intravenous tissue plasminogen activator therapy: sonographic classification and short-term improvement. Circulation 2001;103:2897–2902.
25.
Alexandrov AV, Grotta JC: Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator. Neurology 2002;59:862–867.
26.
Singer OC, Sitzer M, du Mesnil de RR, Neumann-Haefelin T: Practical limitations of acute stroke MRI due to patient-related problems. Neurology 2004;62:1848–1849.
27.
Kane I, Sandercock P, Wardlaw J: Magnetic resonance perfusion diffusion mismatch and thrombolysis in acute ischaemic stroke: a systematic review of the evidence to date. J Neurol Neurosurg Psychiatry 2007;78:485–491.
© 2008 S. Karger AG, Basel
2008
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.