Transcranial Doppler correlation with cerebral angiography in sickle cell disease.

Abstract

Background and Purpose: Cerebral infarction in sickle cell disease is associated with arterial narrowing or occlusions of intracranial arteries. Primary stroke prevention would be feasible if a noninvasive screening test could be developed to detect intracranial disease in patients before symptoms develop.Methods: To determine the sensitivity and specificity of transcranial Doppler in detecting significant (>50% lumen diameter reduction) intracranial arterial lesions, we compared transcranial Doppler and cerebral angiography in a primarily young, symptomatic group of 33 patients (18 males and 15 females) with sickle cell disease.Results: From a total of 34 examinations, transcranial Doppler detected significant abnormalities in 26 of 29 (sensitivity 90%, specificity 100%). Five were normal by both techniques. The transorbital examination detected abnormalities in two patients whose studies were otherwise unremarkable.Conclusions: Transcranial Doppler is sensitive and specific for the detection of arterial vasculopathy of sickle cell disease. Screening should include a transorbital examination of the distal internal carotid artery as well as examination using the transtemporal approach. (Stroke 1992;23:1073-1077 KEY WORDS • cerebral infarction • child • anemia, sickle cell • ultrasonics

The Leicester cerebral haemodynamics database: normative values and the influence of age and sex

“…Due to its relatively low-cost, portability and exceptional temporal resolution, TCD has been the main tool in studies of cerebral haemodynamics. Since its introduction, normative values of cerebral blood flow velocity (CBFV), which correlates well with changes in absolute CBF, have been reported (Adams et al 1992, Bakker et al 2004). However, in contrast to other physiological systems, direct measurements of CBFV or related parameters, such as the Pulsatility Index (Adams et al 1992), do not provide the discriminatory power required to detect abnormalities of the cerebral circulation.…”

“…Since its introduction, normative values of cerebral blood flow velocity (CBFV), which correlates well with changes in absolute CBF, have been reported (Adams et al 1992, Bakker et al 2004). However, in contrast to other physiological systems, direct measurements of CBFV or related parameters, such as the Pulsatility Index (Adams et al 1992), do not provide the discriminatory power required to detect abnormalities of the cerebral circulation. Due to the highly effective control exerted by the mechanism of pressure-autoregulation, CBF is normally maintained within narrow limits for mean blood pressures (MBP) in the range 60-150 mm Hg (Paulson, Strandgaard & Edvinsson 1990).…”

Sickle Cell Disease: Reference Values and Interhemispheric Differences of Nonimaging Transcranial Doppler Blood Flow Parameters

“…1,9 Substantial side-to-side differences in flow velocities in individual children without any arterial stenosis, 10 however, indicate that extrapolation of average group symmetry in flow velocities to individual children with SCD may not be correct.…”

Neurological Complications and MRI

“…Three groups have been identified with increasing risk of stroke: normal TCD velocities (<170cm/s), conditional TCD velocities (170-200cm/s) and abnormal velocities (>200cm/s) [43]. The Stroke Prevention (STOP) trial randomised children with abnormal TCD velocities (>200 cm/s) to regular transfusion and was discontinued early as an interim analysis showed that there was a 92% reduction in the risk stroke in the transfused arm [44,45].…”