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Trans Cranial Doppler

Transcranial Doppler (TCD) is a test that measures the velocity of blood flow through the brain's blood vessels. Used to help in the diagnosis of emboli, stenosis, vasospasm from a subarachnoid hemorrhage (bleeding from a ruptured aneurysm), and other problems, this relatively quick and inexpensive test is growing in popularity in the United States. The equipment used for these tests is becoming increasingly portable, making it possible for a clinician to travel to a hospital, doctor's office or nursing home for both inpatient and outpatient studies. It is often used in conjunction with other tests such as MRI, MRA, carotid duplex ultrasound and CT scans.

Cerebrovascular Diseases can be realistically explored and studied with the use of Transcranial Doppler. We perform a comprehensive and detailed protocol for understanding and interrogating a wide variety of neurovascular pathology:
  • Carotid stenosis/occlusion
  • Intracranial Stenosis
  • Cerebral Emboli Detection
  •  Cerebral Vasospasm
  • Arteriovenous Malformations
  • Head Trauma
  • Cerebral Circulatory Arrest
  • Diminished Vasomotor Reactivity
  • Reduced/Absent Cerebral Autoregulation
  • Variations in Circle of Willis

Advantages and Limitations of TCD

TCD is relatively inexpensive, noninvasive, portable and fairly easy to use. It allows frequent repeated measurements and continuous monitoring. Immediate, real time detection of changes in cerebrovascular hemodynamics is possible. It can be utilized by any medical specialty to evaluate several neurovascular disorders.

In many communities (especially rural ones), there is no neurologist and/or MRI machine available for appropriate stroke workup. In those settings and in many other places a "complete" stroke workup consists of carotid Doppler and two-dimensional echocardiogram. This misses the important evaluation of intracranial vasculature. A TCD may be the inexpensive, simple mean to determine which patients must be referred to a specialized center for further evaluation. In addition, and in patients who decline intervention initially, TCD gives a tool for monitoring the identified lesions through the years and evaluate the effectiveness of medical treatment.

Finally, TCD may be the only mean possible to evaluate intracranial vessels in cases when other radiographic means are contraindicated. TCD is a "blind procedure"; its accuracy relies on the knowledge and experience of a trained technician and interpreter. It has limited ability to detect distal branches of intracranial vessels. In 5% to 10% of cases, sufficient penetration of the bone window cannot be achieved for ample insonation.
 
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