Diagnostic Approach to Cerebrovascular Disease: Ultrasound

Abstract

The ultrasound interrogation of the superior aortic system includes the approach to diverse arterial segments pertaining both to the extracranial and to the intracranial segments of the circulation. The so-called carotid Doppler examination actually comprises more imaging techniques and modalities addressing the various arterial segments. Ultrasound examination has numerous advantages (being safe, non-invasive, less expensive, with no allergic risk) and can be repeatedly carried out with no additional risk for the patient. In any of its modalities, ultrasound requires well trained specialists as this examination is operator-dependent in an important degree. Unparalleled anatomical and functional details with clinical and surgical relevance are particularly offered by the ultrasound interrogation. All these elements are richly illustrated and explained in the present chapter. The role of ultrasound examination is underscored not only regarding the diagnostic approach but also in the follow up of patients either not operated or in those undergoing surgery or endovascular procedures.

In an era of a more complex and sophisticated medicine, the ultrasound exploration of the extra- and intracerebral vessels can become, as well as other complementary techniques, either the best or the worst of examinations. Undoubtedly, it will be the worst if trivialized, if practiced at every street corner and out of the clinical context, thus bringing about either a false sense of security or that of unmotivated fear. Marie-Germaine Bousser

The substantial advantages of this method [i.e., ultrasound] are counterbalanced by the subjectiveness in gaining and portraying the graphic or acoustic input signals. Data obtained from our patients should be interpreted in the general clinical context; as in other fields of biology, treatment options do not emanate solely from an EEG trace or from a blood test. The practice of treating an echographic image or a Doppler wave must certainly vanish from ultrasonographical practice.Pierre-Jean Touboul