Abstract
Over the last few years, many authors have described the possibility of using transcranial Doppler to demonstrate the passage of microemboli in the cerebral arteries. We report the case of a 44-year-old woman with thrombotic diathesis and thrombocytosis who was admitted twice within a short period of time (one and a half months) to a neurological department because of multiple cerebral infarctions. On the occasion of the second admission, a colour-Doppler examination of the epiaortic vessels, which had previously been negative, showed a carotid lesion due to a mural thrombus and, on the same side as the carotid lesion, transcranial Doppler detected short-duration, high-intensity signals in the middle and anterior cerebral arteries, an expression of the passage of microemboli.
As already described by other authors in similar clinical situations, our case confirms that transcranial Doppler can identify the passage of microemboli in the circle of Willis.
Sommario
Negli ultimi anni è stata descritta da molti autori la possibilità di dimostrare mediante Doppler transcranico il passaggio di microemboli nelle arterie cerebrali. Riportiamo il caso di una donna di 44 anni con diatesi trombotica e trombocitosi ricoverata per due volte, a breve distanza di tempo (un mese e mezzo), in ambiente neurologico per infarti cerebrali multipli. In occasione del secondo ricovero l'esame Color-Doppler dei vasi epiaortici, che era risultato negativo in precedenza, ha evidenziato una lesione carotidea riferibile a un trombo murale e al Doppler transcranico sono stati rilevati, omolateralmente alla lesione carotidea, segnali di breve durata ed alta intensità nelle arterie cerebrali media e anteriore, espressione di passaggio di microemboli.
Come già descritto da alcuni autori in situazioni cliniche simili, il nostro caso conferma la possibilità di individuare, mediante Doppler transcranico, il passaggio di microemboli nel circolo cerebrale.
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References
Consensus Committee of the ninth international cerebral hemodynamic symposium.Special Report:Basic identification criteria of Doppler microembolic signals. Stroke, 26: 1123, 1995.
Deklunder G.:The high intensity transient signals (HITS). Sang Thrombose Vaisseaux, 6: 697–698, 1994.
Fieschi C., Argentino C., Lenzi G.L., Sacchetti M.L., Toni D., Bozzao L.:Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours. J. Neurol. Sci. 91: 311–322, 1989.
Fisher M., Martin A., Cosgrove M., Norris J.:Stroke symptoms from carotid artery plaques. Stroke, 25:272, 1994.
Georgiadis S., Mackay T.G., Kelman A.W., Grosset D.G., Wheatley D.J., Lees K.R.:Differentiation between gaseous and formed embolic materials in vivo. Stroke, 25:1559–1563, 1994.
Georgiadis D., Kaps M., Siebler M., Hill M., König M., Berg J., Kahl M., Zunker P., Dehl B., Ringelstein E.B.:Variability of Doppler microembolic signal counts in patients with prosthetic cardiac valves. Stroke. 26: 439–443, 1995.
Glen S., Grosset D., Lees K.:Anticoagulant monitoring with transcranial Doppler. The Lancet, 345, 7:57–58, 1994.
Grosset D.G., Georgiadis D., Kelman A.W., Lees K.L.:Quantification of ultrasound emboli signals in patients with cardiac and carotid disease. Stroke, 24: 1922–1924, 1993.
Markus H.S., Brown M.M.:Differentiation between different pathological cerebral embolic materials using transcranial Doppler in an in vitro model. Stroke, 24: 1–5, 1993.
Rams J.J., Davis D.A., Lolley D.M., Berger M.P., Spencer M.P.:Detection of microemboli in patients with artificial heart valves using transcranial Doppler: preliminary observation. J. Heart Valv. Dis. 2: 37–41, 1993.
Siebler M., Sitzer M., Steinmetz H.:Detection of intracranial emboli in patients with symptomatic extracranial carotid artery disease. Stroke, 23: 1652–1654, 1992.
Siebler M., Nachtman A., Sitzer M., Steinmetz H.:Anticoagulant monitoring and cerebral microemboli detection. The Lancet, 344, 20: 555, 1994.
Siebler M., Kleinschmidt A., Sitzer M., Steinmetz H., Freud H.J.:Cerebral microembolism in symptomatic and asymptomatic high-grade internal carotid artery stenosis. Neurology, 44: 615–618, 1994.
Sitzet M., Sohngen D., Siebler M. et al.:Cerebral microembolism in patients with Sneddon's syndrome. Arch. Neurol. 51, 1994.
Spencer M.P., Thomas G.I., Nichols S.C., Sauvage L.R.:Detection of middle cerebral artery emboli during carotid endoarterectomy using transcranial Doppler ultrasonography. Stroke, 21: 415–423, 1990.
Steinmetz H., Siebler M., Sitzer M.: Detection par le Doppler transcranien d'embolies cerebrales silencieuses dans les stenoses carotides. Sang Thrombose Vaisseaux, 10(6): 651–654, 1994.
Sturzeneger M., Beer J.H., Rihs F.:Monitoring combined antithrombotic treatments in patients with prosthetic heart valves using transcranial Doppler and coagulation markers. Stroke, 26: 63–69, 1995.
Valton L., Larrue V., Arruè P. et al.:Asymptomatic cerebral embolic signals in patients with carotid stenosis. Stroke, 26: 813–815, 1995.
Zanette E.M., Roberti C., Mancini G., Pozzilli C., Bragoni M., Toni D.:Spontaneous middle cerebral artery reperfusion in ischemic stroke. Stroke, 26: 430–433, 1995.
Zuilen E.V., Moll F., Vermeulen F.E.E., Mauser H.W., Van Gijn J., Ackerstaff R.G.A.:Detection of cerebral microemboli by means of transcranial Doppler monitoring before and after carotid endoarterectomy. Stroke, 26: 210–213, 1995.
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Solaro, M., Roberti, C., Spalloni, A. et al. Microembolization from a carotid mural thrombus detected by transcranial Doppler. Ital J Neuro Sci 17, 75–78 (1996). https://doi.org/10.1007/BF01995713
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DOI: https://doi.org/10.1007/BF01995713