Book contents
- Frontmatter
- Contents
- Preface
- List of abbreviations
- 1 Stroke in the emergency department
- 2 What to do first
- 3 Ischemic stroke
- 4 TPA protocol
- 5 Neurological deterioration in acute ischemic stroke
- 6 Ischemic stroke prevention: why we do the things we do
- 7 Transient ischemic attack (TIA)
- 8 Intracerebral hemorrhage (ICH)
- 9 Subarachnoid hemorrhage (SAH)
- 10 Organization of stroke care
- 11 Rehabilitation
- Appendix 1 Numbers and calculations
- Appendix 2 IV TPA dosing chart
- Appendix 3 Sample admission orders
- Appendix 4 Sample discharge summary
- Appendix 5 Stroke radiology
- Appendix 6 Transcranial Doppler ultrasound (TCD)
- Appendix 7 Heparin protocol
- Appendix 8 Insulin protocol
- Appendix 9 Medical complications
- Appendix 10 Brainstem syndromes
- Appendix 11 Cerebral arterial anatomy
- Appendix 12 Stroke in the young and less common stroke diagnoses
- Appendix 13 Brain death criteria
- Appendix 14 Neurological scales
- Recommended reading
- References
Appendix 6 - Transcranial Doppler ultrasound (TCD)
Published online by Cambridge University Press: 10 October 2009
- Frontmatter
- Contents
- Preface
- List of abbreviations
- 1 Stroke in the emergency department
- 2 What to do first
- 3 Ischemic stroke
- 4 TPA protocol
- 5 Neurological deterioration in acute ischemic stroke
- 6 Ischemic stroke prevention: why we do the things we do
- 7 Transient ischemic attack (TIA)
- 8 Intracerebral hemorrhage (ICH)
- 9 Subarachnoid hemorrhage (SAH)
- 10 Organization of stroke care
- 11 Rehabilitation
- Appendix 1 Numbers and calculations
- Appendix 2 IV TPA dosing chart
- Appendix 3 Sample admission orders
- Appendix 4 Sample discharge summary
- Appendix 5 Stroke radiology
- Appendix 6 Transcranial Doppler ultrasound (TCD)
- Appendix 7 Heparin protocol
- Appendix 8 Insulin protocol
- Appendix 9 Medical complications
- Appendix 10 Brainstem syndromes
- Appendix 11 Cerebral arterial anatomy
- Appendix 12 Stroke in the young and less common stroke diagnoses
- Appendix 13 Brain death criteria
- Appendix 14 Neurological scales
- Recommended reading
- References
Summary
For various uses of TCD in stroke refer to Alexandrov, Cerebrovascular Ultrasound in Stroke Prevention and Treatment (2004).
There are many uses of TCD:
Diagnosis of intracranial stenosis
Diagnosis of acute occlusion
Monitoring of acute thrombolytic therapy
Vasoreactivity (vascular reserve) with carotid disease
Emboli monitoring
Vascular monitoring during surgery
Detection of right-to-left shunt (RLS) (most commonly patent foramen ovale)
Procedure for right-to-left shunt detection
Based on European Society of Neurosonology and Cerebral Hemodynamics consensus, 1999.
Equipment
TCD
two normal saline bottles 15 cm3
two 10 cm3 syringes
flexible tubing
three-way stopcock
Preparation
The patient must be in the supine position, with the arm horizontal. An intravenous catheter (#18) is inserted into an antecubital vein (connected to a 250 ml bottle of physiologic solution by means of a flexible tube to maintain venous access).
The right middle cerebral artery is traced by means of TCD (the examination is more sensitive if bilateral monitoring is used).
Procedure
Two 10 ml (or 20 ml) syringes are prepared: one containing 9 ml of physiologic solution and the other containing 1 ml of air. By means of a three-way stopcock, the contents of both syringes are rapidly mixed until a homogeneous solution is obtained.
The solution is rapidly injected in bolus form with the patient at rest. Inject with the syringe pointed superiorly so the bubbles aggregate at the top and are injected first.
The MCA is monitored for 40–60 seconds.
The procedure is repeated with Valsalva maneuver
The efficacy of the Valsalva maneuver must be ascertained beforehand through the reduction of the systolic flow velocity on MCA by at least one-third.
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- Acute Stroke CareA Manual from the University of Texas - Houston Stroke Team, pp. 157 - 160Publisher: Cambridge University PressPrint publication year: 2007