Doppler diagnosis in cases of acute stroke

Chambers, Brian R.; Merory, John; Smidt, Vicki

doi:10.5694/j.1326-5377.1989.tb136530.x

Cited by 5 publications

(2 citation statements)

References 3 publications

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“…Based on the studies mentioned previously and our own clinical experience, we recommend a wake-up stroke evaluation proceeds as any other acute stroke assessment, with as much clinical detail as possible, an NIHSS examination and basic laboratory studies according to guidelines. This should be followed by multiparametric CT or MRI with noninvasive angiography or fast-track neurosonology (eg, transcranial Doppler and carotid duplex ultrasonography) [90][91][92][93][94] to screen for an infarction/at-risk mismatch and large arterial occlusion, respectively. Even if one is uncomfortable providing treatment recommendations based on the results given the lack of high-level supporting evidence, the diagnostics can serve to inform prognostication.…”

Section: What To Do With Wake-up Stroke Evaluationmentioning

confidence: 99%

What to do With Wake-Up Stroke

Rubin

Barrett

2015

The Neurohospitalist

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Wake-up stroke, defined as the situation where a patient awakens with stroke symptoms that were not present prior to falling asleep, represents roughly 1 in 5 acute ischemic strokes and remains a therapeutic dilemma. Patients with wake-up stroke were excluded from most ischemic stroke treatment trials and are often not eligible for acute reperfusion therapy in clinical practice, leading to poor outcomes. Studies of neuroimaging with standard noncontrast computed tomography (CT), magnetic resonance imaging (MRI), and multimodal perfusion-based CT and MRI suggest wake-up stroke may occur shortly before awakening and may assist in selecting patients for acute reperfusion therapies. Pilot studies of wake-up stroke treatment based on these neuroimaging features are promising but have limited generalizability. Ongoing randomized treatment trials using neuroimaging-based patient selection may identify a subset of patients with wake-up stroke that can safely benefit from acute reperfusion therapies.

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Section: What To Do With Wake-up Stroke Evaluationmentioning

confidence: 99%

What to do With Wake-Up Stroke

Rubin

Barrett

2015

The Neurohospitalist

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“…The neurosonological examination can play a main role in the early diagnostic work-up of AIS [40][41][42][43][44][45]. The identification, localization and severity grading of arterial lesion in the emergency setting provide a relevant aid for the diagnostic evaluation of patients with acute cerebral ischemia and for selecting among several therapeutical options.…”

Section: Occlusion Site Diagnosis and Neurosonologymentioning

confidence: 99%

Role of Ultrasound Vascular Imaging in the Acute Phase of Stroke

Malferrari¹,

Zedde²,

Marcello³

2008

Vascular Disease Prevention

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Acute ischemic stroke remains one of the main causes of death and disability in the world. The only approved therapy for stroke is the intravenous thrombolysis with recombinant tissue plasminogen activator within 3 h from symptom onset. The European, American and Canadian guidelines define unenhanced brain CT as the only imaging technique mandatory before thrombolysis. Its only goal is the exclusion of hemorrhage and not the diagnosis of ischemia, although the identification of early ischemic changes, involving more than one third of middle cerebral artery territory, was soon used in the therapeutic decision.At the moment the need of vascular imaging in the acute phase of stroke is sustained by several researchers and the practical directions actually in progress are the diagnosis of presence and site of vessel occlusion, whose prognostic role is demonstrated, and the perfusional evaluation for the quantification of core/penumbra mismatch and the overcoming of the time window concept. The ideal tool for identify reliably, easily, reproducibly and cheaply the vascular pattern in each patient is the ultrasound technique, particularly Transcranial Colour-Coded Duplex Sonography. It allows also the real-time monitoring of recanalization process, i.e. the timing of vessel patency restoration.

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