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Transcranial Doppler Sonographic Findings in Middle Cerebral Artery Disease

Transcranial Doppler Sonographic Findings in Middle Cerebral Artery Disease Abstract • The transcranial Doppler sonographic findings of 61 patients with middle cerebral artery (MCA) disease were compared with those of 535 controls. According to computed tomographic, angiographic, and/or autopsy findings, the patients were classified as having MCA occlusive lesions in the central (sphenoidal) part or in peripheral branches or MCA stenosis. With MCA lesions, the MCA flow velocity (FV) was reduced. At the same time the anterior cerebral artery FV increased because of collateral flow over leptomeningeal anastomoses. Central MCA lesions showed less marked changes than did peripheral lesions. In MCA stenosis a steep rise of MCA FV appeared inside the stenotic segment. If there was a high-grade stenosis or occlusion of the internal carotid artery, a collateral circulation over the anterior part of the circle of Willis was seen in addition to the changes caused by the MCA disease. From these hemodynamic changes, transcranial Doppler sonographic diagnostic criteria for MCA occlusive and stenotic lesions were established. References 1. Aaslid R, Markwalder TM, Nornes H: Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries . J Neurosurg 1982;57:769-774.Crossref 2. Aaslid R, Huber P, Nornes H: Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound . J Neurosurg 1984;60:37-41.Crossref 3. Seiler RW, Grolimund P, Aaslid R, et al: Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage . J Neurosurg 1986;64:594-600.Crossref 4. Lindegaard KF, Bakke SJ, Grolimund P, et al: Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound . J Neurosurg 1985;63:890-898.Crossref 5. Lindegaard KF, Bakke SJ, Aaslid R, et al: Doppler diagnosis of intracranial artery occlusive disorders . J Neurol Neurosurg Psychiatry 1986;49:510-518.Crossref 6. Lindegaard KF, Grolimund P, Aaslid R, et al: Evaluation of cerebral arteriovenous malformations using transcranial Doppler ultrasound . J Neurosurg 1986;65:335-344.Crossref 7. Schwartz A, Hennerici M: Noninvasive transcranial Doppler ultrasound in intracranial angiomas . Neurology 1986;36:626-635.Crossref 8. Aaslid R, Lundar T, Lindegaard KF, et al: Estimation of cerebral perfusion pressure from arterial blood pressure and transcranial Doppler technique , in Miller JD, Teasdale GM, Rowan JO, et al: Intracranial Pressure . New York, Springer Publishing Co Inc, 1986, vol 4, pp 226-229. 9. Grolimund P, Seiler RW, Aaslid R, et al: Evaluation of cerebrovascular disease by combined extracranial and transcranial Doppler sonography: Experience in 1039 patients . Stroke 1987;18. 10. Ringelstein EB: Transcranial Doppler monitoring , in Aaslid R (ed): Transcranial Doppler Sonography . New York, Springer-Verlag NY Inc, 1986, pp 147-163. 11. Baker DW: Pulsed ultrasonic Doppler blood flow sensing . IEEE Proc Sonics Ultrasonics SU 1970;17:170-182.Crossref 12. Peronneau P, Hinglais J, Pellet M, et al: Velocimètre sanguin par effet Doppler à émission ultrasonore pulsée . L'Onde Electrique 1970;50:369-389. 13. Arnolds BJ, von Reutern GM: Transcranial Doppler sonography: Examination technique and normal reference values . Ultrasound Med Biol 1986;12:115-123.Crossref 14. Seiler R, Grolimund P, Zurbrügg H: Die transkranielle Doppler sonographie: Eine neue Methode zur Diagnostik zerebrovaskulärer Erkrankungen . Schweiz Med Wochenschr 1986;116:626-634. 15. Keller H: Doppler-Sonographie der hirnversorgenden Arterien: Anatomische, physiologische und apparative Grundlagen , in Kriessmann A, Bollinger A, Keller H (eds): Ultraschall-Doppler-Diagnostik in der Angiologie , ed 2. Stuttgart, West Germany, Georg Thieme Verlag, 1979, pp 117-182. 16. Büdingen HJ, von Reutern GM, Freund HJ: Doppler-Sonographie der extrakraniellen Hirnarterien: Grundlagen, Methodik, Fehlermöglichkeiten, Ergebnisse . Stuttgart, West Germany, Georg Thieme Verlag, 1982. 17. Von Reutern GM: Doppler-Sonographie der hirnversorgenden Arterien mit besonderer Berücksichtigung der direkten Kriterien , in Kriessmann A, Bollinger A, Keller H (eds): Ultraschall-Doppler-Diagnostik in der Angiologie , ed 2. Stuttgart, West Germany, Georg Thieme Verlag, 1979, pp 183-211. 18. Gosling RG, King DH: Arterial assessment by Doppler-shift ultrasound . Proc R Soc Med 1974;67:447-449. 19. Grolimund P, Seiler RW: Age dependence of the flow velocity in the basal cerebral arteries: A transcranial Doppler ultrasound study. Ultrasound Med Biol, in press. 20. Harvey J, Rasmussen T: Occlusion of the middle cerebral artery: An experimental study . Arch Neurol Psychiatry 1951;66:20-26.Crossref 21. Taveras JM: Angiographic observation in occlusive cerebrovascular disease . Neurology 1961;11:86-90.Crossref 22. Lascelles RG, Burrows EH: Occlusion of the middle cerebral artery . Brain 1965;88:85-96.Crossref 23. Larson SJ, Love L, Timmons C: Segmental occlusion of the middle cerebral artery . AJR 1965;94:223-229. 24. Shenkin HA, Haft H, Somach FM: Prognostic significance of arteriography in non-hemorrhagic strokes . JAMA 1965;194:612-616.Crossref 25. Krayenbühl H, Yasargil MG: Verschluss der Arteria cerebralis media: Ergebnisse der klinischen und katamnestischen Untersuchungen . Schweiz Arch Neurol Neurochir Psychiatry 1966;94:287-304. 26. Huber P: Die prognostische Bedeutung des angiographisch sichtbaren Kollateralkreislaufs bei Verschlüssen der Arteria cerebri media . Fortschr Röntgenstr 1966;104:82-89.Crossref 27. Allcock JM: Occlusion of the middle cerebral artery: Serial angiography as a guide to conservative therapy . J Neurosurg 1967;27:353-363.Crossref 28. Sindermann F, Dichgans J, Bergleiter R: Occlusion of the middle cerebral artery and its branches: Angiographic and clinical correlates . Brain 1969;92:607-620.Crossref 29. Huber P, Krayenbühl H, Yasargil MG: Zerebrale Angiographie für Klinik und Praxis . Stuttgart, West Germany, Georg Thieme Verlag, 1979. 30. Ishikawa S, Handa J, Meyer JW, et al: Haemodynamics of the circle of Willis and the leptomeningeal anastomosis: An electromagnetic flowmeter study of intracranial arterial occlusion in the monkey . J Neurol Neurosurg Psychiatry 1965;28:124-136.Crossref 31. Nornes H, Grip A, Wikeby P: Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique: II. Saccular aneurysms . J Neurosurg 1979;50:570-577.Crossref 32. Padayachee TS, Kirkham FJ, Lewis RR, et al: Transcranial measurement of blood velocities in the basal cerebral arteries using pulsed Doppler ultrasound: A method of assessing the circle of Willis . Ultrasound Med Biol 1986;12:5-14.Crossref 33. Lassen NA: The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis within the brain . Lancet 1966;2:1113-1115.Crossref 34. Cronqvist S, Laroche F: Transitory hyperaemia in focal cerebral vascular lesions studied by angiography and regional cerebral blood flow measurements . Br J Radiol 1967;40:270-274.Crossref 35. Fieschi C, Agnoli A, Battistini N, et al: Derangement of regional cerebral blood flow and its regulatory mechanisms in acute cerebrovascular lesions . Neurology 1968;18:1166-1179.Crossref 36. Strandness DJ Jr, Schultz RD, Sumner DS, et al: Ultrasonic flow detection: A useful technique in the evaluation of peripheral vascular disease . Am J Surg 1967;113:311-320.Crossref 37. Aaslid R, Nornes H: Musical murmurs in human cerebral arteries after subarachnoid hemorrhage . J Neurosurg 1984;60:32-36.Crossref 38. Aaslid R: The most difficult problem in transcranial Doppler and some attempts at its solution, in Aaslid R, Eden A, Fieschi C, et al (eds): Advances in Transcranial Doppler Sonography: Proceedings of the First International Conference on Transcranial Doppler-Sonography, Rome, Nov 6-8, 1986. New York, Springer-Verlag NY Inc, in press. 39. Jain KK: Some observations on the anatomy of the middle cerebral artery . Can J Surg 1964;7:134-139. 40. Herman LH, Ostrowski AZ, Guardian ES: Perforating branches of the middle cerebral artery: An anatomical study . Arch Neurol 1963;20:32-34.Crossref 41. Grand W: Microsurgical anatomy of the proximal middle cerebral artery and the internal carotid artery bifurcation . Neurosurgery 1980;7:215-218.Crossref 42. Stabler J: Two cases of accessory middle cerebral artery, including one with an aneurysm at its origin . Br J Radiol 1970;43:314-318.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Transcranial Doppler Sonographic Findings in Middle Cerebral Artery Disease

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1988.00520270067022
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Abstract

Abstract • The transcranial Doppler sonographic findings of 61 patients with middle cerebral artery (MCA) disease were compared with those of 535 controls. According to computed tomographic, angiographic, and/or autopsy findings, the patients were classified as having MCA occlusive lesions in the central (sphenoidal) part or in peripheral branches or MCA stenosis. With MCA lesions, the MCA flow velocity (FV) was reduced. At the same time the anterior cerebral artery FV increased because of collateral flow over leptomeningeal anastomoses. Central MCA lesions showed less marked changes than did peripheral lesions. In MCA stenosis a steep rise of MCA FV appeared inside the stenotic segment. If there was a high-grade stenosis or occlusion of the internal carotid artery, a collateral circulation over the anterior part of the circle of Willis was seen in addition to the changes caused by the MCA disease. From these hemodynamic changes, transcranial Doppler sonographic diagnostic criteria for MCA occlusive and stenotic lesions were established. References 1. Aaslid R, Markwalder TM, Nornes H: Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries . J Neurosurg 1982;57:769-774.Crossref 2. Aaslid R, Huber P, Nornes H: Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound . J Neurosurg 1984;60:37-41.Crossref 3. Seiler RW, Grolimund P, Aaslid R, et al: Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage . J Neurosurg 1986;64:594-600.Crossref 4. Lindegaard KF, Bakke SJ, Grolimund P, et al: Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound . J Neurosurg 1985;63:890-898.Crossref 5. Lindegaard KF, Bakke SJ, Aaslid R, et al: Doppler diagnosis of intracranial artery occlusive disorders . J Neurol Neurosurg Psychiatry 1986;49:510-518.Crossref 6. Lindegaard KF, Grolimund P, Aaslid R, et al: Evaluation of cerebral arteriovenous malformations using transcranial Doppler ultrasound . J Neurosurg 1986;65:335-344.Crossref 7. Schwartz A, Hennerici M: Noninvasive transcranial Doppler ultrasound in intracranial angiomas . Neurology 1986;36:626-635.Crossref 8. Aaslid R, Lundar T, Lindegaard KF, et al: Estimation of cerebral perfusion pressure from arterial blood pressure and transcranial Doppler technique , in Miller JD, Teasdale GM, Rowan JO, et al: Intracranial Pressure . New York, Springer Publishing Co Inc, 1986, vol 4, pp 226-229. 9. Grolimund P, Seiler RW, Aaslid R, et al: Evaluation of cerebrovascular disease by combined extracranial and transcranial Doppler sonography: Experience in 1039 patients . Stroke 1987;18. 10. Ringelstein EB: Transcranial Doppler monitoring , in Aaslid R (ed): Transcranial Doppler Sonography . New York, Springer-Verlag NY Inc, 1986, pp 147-163. 11. Baker DW: Pulsed ultrasonic Doppler blood flow sensing . IEEE Proc Sonics Ultrasonics SU 1970;17:170-182.Crossref 12. Peronneau P, Hinglais J, Pellet M, et al: Velocimètre sanguin par effet Doppler à émission ultrasonore pulsée . L'Onde Electrique 1970;50:369-389. 13. Arnolds BJ, von Reutern GM: Transcranial Doppler sonography: Examination technique and normal reference values . Ultrasound Med Biol 1986;12:115-123.Crossref 14. Seiler R, Grolimund P, Zurbrügg H: Die transkranielle Doppler sonographie: Eine neue Methode zur Diagnostik zerebrovaskulärer Erkrankungen . Schweiz Med Wochenschr 1986;116:626-634. 15. Keller H: Doppler-Sonographie der hirnversorgenden Arterien: Anatomische, physiologische und apparative Grundlagen , in Kriessmann A, Bollinger A, Keller H (eds): Ultraschall-Doppler-Diagnostik in der Angiologie , ed 2. Stuttgart, West Germany, Georg Thieme Verlag, 1979, pp 117-182. 16. Büdingen HJ, von Reutern GM, Freund HJ: Doppler-Sonographie der extrakraniellen Hirnarterien: Grundlagen, Methodik, Fehlermöglichkeiten, Ergebnisse . Stuttgart, West Germany, Georg Thieme Verlag, 1982. 17. Von Reutern GM: Doppler-Sonographie der hirnversorgenden Arterien mit besonderer Berücksichtigung der direkten Kriterien , in Kriessmann A, Bollinger A, Keller H (eds): Ultraschall-Doppler-Diagnostik in der Angiologie , ed 2. Stuttgart, West Germany, Georg Thieme Verlag, 1979, pp 183-211. 18. Gosling RG, King DH: Arterial assessment by Doppler-shift ultrasound . Proc R Soc Med 1974;67:447-449. 19. Grolimund P, Seiler RW: Age dependence of the flow velocity in the basal cerebral arteries: A transcranial Doppler ultrasound study. Ultrasound Med Biol, in press. 20. Harvey J, Rasmussen T: Occlusion of the middle cerebral artery: An experimental study . Arch Neurol Psychiatry 1951;66:20-26.Crossref 21. Taveras JM: Angiographic observation in occlusive cerebrovascular disease . Neurology 1961;11:86-90.Crossref 22. Lascelles RG, Burrows EH: Occlusion of the middle cerebral artery . Brain 1965;88:85-96.Crossref 23. Larson SJ, Love L, Timmons C: Segmental occlusion of the middle cerebral artery . AJR 1965;94:223-229. 24. Shenkin HA, Haft H, Somach FM: Prognostic significance of arteriography in non-hemorrhagic strokes . JAMA 1965;194:612-616.Crossref 25. Krayenbühl H, Yasargil MG: Verschluss der Arteria cerebralis media: Ergebnisse der klinischen und katamnestischen Untersuchungen . Schweiz Arch Neurol Neurochir Psychiatry 1966;94:287-304. 26. Huber P: Die prognostische Bedeutung des angiographisch sichtbaren Kollateralkreislaufs bei Verschlüssen der Arteria cerebri media . Fortschr Röntgenstr 1966;104:82-89.Crossref 27. Allcock JM: Occlusion of the middle cerebral artery: Serial angiography as a guide to conservative therapy . J Neurosurg 1967;27:353-363.Crossref 28. Sindermann F, Dichgans J, Bergleiter R: Occlusion of the middle cerebral artery and its branches: Angiographic and clinical correlates . Brain 1969;92:607-620.Crossref 29. Huber P, Krayenbühl H, Yasargil MG: Zerebrale Angiographie für Klinik und Praxis . Stuttgart, West Germany, Georg Thieme Verlag, 1979. 30. Ishikawa S, Handa J, Meyer JW, et al: Haemodynamics of the circle of Willis and the leptomeningeal anastomosis: An electromagnetic flowmeter study of intracranial arterial occlusion in the monkey . J Neurol Neurosurg Psychiatry 1965;28:124-136.Crossref 31. Nornes H, Grip A, Wikeby P: Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique: II. Saccular aneurysms . J Neurosurg 1979;50:570-577.Crossref 32. Padayachee TS, Kirkham FJ, Lewis RR, et al: Transcranial measurement of blood velocities in the basal cerebral arteries using pulsed Doppler ultrasound: A method of assessing the circle of Willis . Ultrasound Med Biol 1986;12:5-14.Crossref 33. Lassen NA: The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis within the brain . Lancet 1966;2:1113-1115.Crossref 34. Cronqvist S, Laroche F: Transitory hyperaemia in focal cerebral vascular lesions studied by angiography and regional cerebral blood flow measurements . Br J Radiol 1967;40:270-274.Crossref 35. Fieschi C, Agnoli A, Battistini N, et al: Derangement of regional cerebral blood flow and its regulatory mechanisms in acute cerebrovascular lesions . Neurology 1968;18:1166-1179.Crossref 36. Strandness DJ Jr, Schultz RD, Sumner DS, et al: Ultrasonic flow detection: A useful technique in the evaluation of peripheral vascular disease . Am J Surg 1967;113:311-320.Crossref 37. Aaslid R, Nornes H: Musical murmurs in human cerebral arteries after subarachnoid hemorrhage . J Neurosurg 1984;60:32-36.Crossref 38. Aaslid R: The most difficult problem in transcranial Doppler and some attempts at its solution, in Aaslid R, Eden A, Fieschi C, et al (eds): Advances in Transcranial Doppler Sonography: Proceedings of the First International Conference on Transcranial Doppler-Sonography, Rome, Nov 6-8, 1986. New York, Springer-Verlag NY Inc, in press. 39. Jain KK: Some observations on the anatomy of the middle cerebral artery . Can J Surg 1964;7:134-139. 40. Herman LH, Ostrowski AZ, Guardian ES: Perforating branches of the middle cerebral artery: An anatomical study . Arch Neurol 1963;20:32-34.Crossref 41. Grand W: Microsurgical anatomy of the proximal middle cerebral artery and the internal carotid artery bifurcation . Neurosurgery 1980;7:215-218.Crossref 42. Stabler J: Two cases of accessory middle cerebral artery, including one with an aneurysm at its origin . Br J Radiol 1970;43:314-318.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Mar 1, 1988

References