854 Transcranial Doppler or transoesophageal echocardiography for the detection of venous-to-arterial circulation shunts

Sastry, Sanjay; Daly, Kevin; Macnab, Anita; Ray, S.; McCollum, Charles

doi:10.1016/s1525-2167(03)90978-4

Cited by 5 publications

(9 citation statements)

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“…Our study was not sufficiently powered, as we based the original power calculations on a pilot study done before v-aCS criteria for patent foramen ovale (significant v-aCS) had been worked out 16. Percutaneous closure of patent foramen ovale is used increasingly for atrial septal aneurysms with multiple embolic events.…”

Section: Discussionmentioning

confidence: 99%

“…For participants who had unilateral monitoring of middle cerebral arteries, we duplicated the number of embolic signals to equate to bilateral monitoring. We based the criteria for “significant” v-aCS on our study comparing transcranial Doppler with the diagnosis of patent foramen ovale on transoesophageal echocardiography 16. As we use a rigorously standardised protocol for provocation testing, we prefer the following definition of significant v-aCS to that of the International Consensus Committee 27.…”

Section: Methodsmentioning

confidence: 99%

“…As we use a rigorously standardised protocol for provocation testing, we prefer the following definition of significant v-aCS to that of the International Consensus Committee 27. We defined a significant v-aCS (criteria for patent foramen ovale) as transcranial Doppler detection of ≥ 15 embolic signals within 12 cardiac cycles of contrast injection 16. We defined a “major” v-aCS as either = 50 embolic signals at rest or = 10 at rest and = 80 after provocation by coughing or Valsalva manoeuvre.…”

Section: Methodsmentioning

confidence: 99%

“…We standardised a minimally invasive transcranial Doppler technique to detect v-aCS and did a pilot study in patients with Alzheimer's disease or vascular dementia 16 17. SCE and v-aCS were more common in dementia patients than in community controls.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: casecontrol study

Purandare

Burns

Daly

et al. 2006

BMJ

113

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Objective To compare the occurrence of spontaneous cerebral emboli and venous to arterial circulation shunts in patients with Alzheimer's disease or vascular dementia and controls without dementia. Design Cross sectional case-control study. Setting Secondary care old age psychiatry services, Manchester. Participants 170 patients with dementia (85 with Alzheimer's disease, 85 with vascular dementia) and 150 age and sex matched controls. Patients on anticoagulant treatment, patients with severe dementia, and controls with marked cognitive impairment were excluded. Main outcome measures Frequencies of detection of spontaneous cerebral emboli during one hour monitoring of the middle cerebral arteries with transcranial Doppler and venous to arterial circulation shunts by a transcranial Doppler technique using intravenous microbubbles as an ultrasound contrast. Results Spontaneous cerebral emboli were detected in 32 (40%) of patients with Alzheimer's disease and 31 (37%) of those with vascular dementia compared with just 12 each (15% and 14%) of their controls, giving significant odds ratios adjusted for vascular risk factors of 2.70 (95% confidence interval 1.18 to 6.21) for Alzheimer's disease and 5.36 (1.24 to 23.18) for vascular dementia. These spontaneous cerebral emboli were not caused by carotid disease, which was equally frequent in dementia patients and their controls. A venous to arterial circulation shunt indicative of patent foramen ovale was found in 27 (32%) Alzheimer's disease patients and 25 (29%) vascular dementia patients compared with 19 (22%) and 17 (20%) controls, giving non-significant odds ratios of 1.57 (0.80 to 3.07) and 1.67 (0.81 to 3.41). Conclusion Spontaneous cerebral emboli were significantly associated with both Alzheimer's disease and vascular dementia. They may represent a potentially preventable or treatable cause of dementia.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: casecontrol study

Purandare

Burns

Daly

et al. 2006

BMJ

113

View full text Add to dashboard Cite

show abstract

“…TCD monitoring of MCA with injection of 'air in saline' ultrasound contrast was used for detection of v-aCS (as per the standardised protocol which is in keeping with the international consensus) [16]. Based on the previous validation study, a 'significant' v-aCS, indicative of patent foramen ovale (PFO), was defined as detection in MCA of 15 or more embolic signals with in 12 cardiac cycles of the injection of ultrasound contrast [17,18]. Venous blood was collected for lipid profile and apolipoprotein E allele and magnetic resonance imaging (MRI) of the brain was conducted to measure cerebrovascular disease.…”

Section: Methodsmentioning

confidence: 99%