Skip to main content
SpringerLink
Log in

Sonographische Diagnostik in der neurologischen Notfall- und Intensivmedizin

Sonographic diagnostics in neurological emergency and intensive care medicine

  • Übersichten
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Der Artikel gibt einen Überblick über den aktuellen Stand der neurosonographischen Notfall- und Intensivdiagnostik.

Methoden

Selektive Literaturrecherche mit kritischer Beurteilung ab dem Jahr 1984 sowie nationaler und internationaler Leitlinien.

Ergebnisse

Neben der raschen validen Abklärung akuter Schlaganfälle bieten verschiedene sonographische Monitoringverfahren gerade in der Intensivmedizin ultraschallspezifische Vorteile wie die beliebig häufige Wiederholbarkeit am Patientenbett selbst und die Darstellung in Echtzeit. Zudem machen innovative Entwicklungen die Neurosonographie auch wissenschaftlich zu einem interessanten Gebiet.

Schlussfolgerung

Die neurosonographische Diagnostik nimmt seit Jahren einen wichtigen Stellenwert in der neurologischen Notfall- und Intensivdiagnostik ein. Weitere Anstrengungen sind notwendig, um die Verbreitung der Methode weiter zu unterstützen.

Abstract

Background

This article gives an up-to-date overview of neurosonographic emergency and intensive care diagnostics.

Methods

Selective literature research from 1984 with critical appraisal and including national and international guidelines.

Results

Fast and valid diagnostics in acute stroke is the main field of application of neurosonography. Specific monitoring methods bear great advantages for intensive care patients, especially “as-often-as-wanted” repetitive imaging under real-time conditions. A number of new developments make neurosonography an interesting area of research.

Conclusions

Neurosonography has played a key role in neurological emergency and intensive care medicine for many years. It remains important to continuously support dissemination of the method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Aaslid R (2006) Cerebral autoregulation and vasomotor reactivity. Front Neurol Neurosci 21:216–228

    Article  PubMed  Google Scholar 

  2. Aaslid R (2002) Transcranial Doppler assessment of cerebral vasospasm. Eur J Ultrasound 16:3–10

    Article  PubMed  Google Scholar 

  3. Aaslid R, Huber P, Nornes H (1984) Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60:37–41

    Article  PubMed  CAS  Google Scholar 

  4. Aboyans V, Lacroix P, Jeannicot A et al (2004) A new approach for the screening of carotid lesions: a ‚fast-track‘ method with the use of new generation hand-held ultrasound devices. Eur J Vasc Endovasc Surg 28:317–322

    Article  PubMed  CAS  Google Scholar 

  5. Alexandrov AV, Demchuk AM, Burgin WS et al (2004) Ultrasound-enhanced thrombolysis for acute ischemic stroke: phase I. Findings of the CLOTBUST trial. J Neuroimaging 14:113–117

    PubMed  Google Scholar 

  6. Alexandrov AV, Molina CA, Grotta JC et al (2004) Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 351:2170–2178

    Article  PubMed  CAS  Google Scholar 

  7. Arning C, Widder B, Von Reutern GM et al (2010) Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement. Ultraschall Med 31:251–257

    Article  PubMed  CAS  Google Scholar 

  8. Bauerle J, Nedelmann M (2011) Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol 258:2014–2019

    Article  PubMed  Google Scholar 

  9. Baumgartner RW, Baumgartner IB (1996) Transcranial Doppler and color duplex ultrasound. Familiar and new uses. Ultraschall Med 17:50–54

    Article  PubMed  CAS  Google Scholar 

  10. Baumgartner RW, Mattle HP, Schroth G (1999) Assessment of >/= 50% and < 50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 30:87–92

    Article  PubMed  CAS  Google Scholar 

  11. Becker G, Bogdahn U, Strassburg HM et al (1994) Identification of ventricular enlargement and estimation of intracranial pressure by transcranial color-coded real-time sonography. J Neuroimaging 4:17–22

    PubMed  CAS  Google Scholar 

  12. Budohoski KP, Reinhard M, Aries MJ et al (2011) Monitoring cerebral autoregulation after head injury. Which component of transcranial Doppler flow velocity is optimal? Neurocrit Care

  13. Bundesärztekammer WBD (1998) Dtsch Arztebl 95:1861–1868

    Google Scholar 

  14. Chernyshev OY, Garami Z, Calleja S et al (2005) Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia. Stroke 36:32–37

    Article  PubMed  Google Scholar 

  15. Czosnyka M, Brady K, Reinhard M et al (2009) Monitoring of cerebrovascular autoregulation: facts, myths, and missing links. Neurocrit Care 10:373–386

    Article  PubMed  Google Scholar 

  16. Czosnyka M, Smielewski P, Kirkpatrick P et al (1996) Monitoring of cerebral autoregulation in head-injured patients. Stroke 27:1829–1834

    Article  PubMed  CAS  Google Scholar 

  17. De Bray JM, Missoum A, Dubas F et al (1997) Detection of vertebrobasilar intracranial stenoses: transcranial Doppler sonography versus angiography. J Ultrasound Med 16:213–218

    Google Scholar 

  18. De Rooij NK, Linn FH, Van Der Plas JA et al (2007) Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 78:1365–1372

    Article  Google Scholar 

  19. Demchuk AM, Christou I, Wein TH et al (2000) Accuracy and criteria for localizing arterial occlusion with transcranial Doppler. J Neuroimaging 10:1–12

    PubMed  CAS  Google Scholar 

  20. Diehl RR, Linden D, Lucke D et al (1995) Phase relationship between cerebral blood flow velocity and blood pressure. A clinical test of autoregulation. Stroke 26:1801–1804

    Article  PubMed  CAS  Google Scholar 

  21. Dittrich R, Dziewas R, Ritter MA et al (2006) Negative ultrasound findings in patients with cervical artery dissection. Negative ultrasound in CAD. J Neurol 253:424–433

    Article  PubMed  CAS  Google Scholar 

  22. Dittrich R, Ringelstein EB (2008) Occurrence and clinical impact of microembolic signals during or after cardiosurgical procedures. Stroke 39:503–511

    Article  PubMed  Google Scholar 

  23. Dorigo W, Pulli R, Nesi M et al (2011) Urgent carotid endarterectomy in patients with recent/crescendo transient ischaemic attacks or acute stroke. Eur J Vasc Endovasc Surg 41:351–357

    Article  PubMed  CAS  Google Scholar 

  24. Ducrocq X, Hassler W, Moritake K et al (1998) Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology. J Neurol Sci 159:145–150

    Article  PubMed  CAS  Google Scholar 

  25. Eggers J, Konig IR, Koch B et al (2008) Sonothrombolysis with transcranial color-coded sonography and recombinant tissue-type plasminogen activator in acute middle cerebral artery main stem occlusion: results from a randomized study. Stroke 39:1470–1475

    Article  PubMed  CAS  Google Scholar 

  26. Eggers J, Seidel G, Koch B et al (2005) Sonothrombolysis in acute ischemic stroke for patients ineligible for rt-PA. Neurology 64:1052–1054

    Article  PubMed  Google Scholar 

  27. Eyding J, Geier B, Staub D (2011) Current strategies and possible perspectives of ultrasonic risk stratification of ischemic stroke in internal carotid artery disease. Ultraschall Med 32:267–273

    Article  PubMed  CAS  Google Scholar 

  28. Eyding J, Nolte-Martin A, Krogias C et al (2007) Changes of contrast-specific ultrasonic cerebral perfusion patterns in the course of stroke; reliability of region-wise and parametric imaging analysis. Ultrasound Med Biol 33:329–334

    Article  PubMed  Google Scholar 

  29. Gerriets T, Goertler M, Stolz E et al (2002) Feasibility and validity of transcranial duplex sonography in patients with acute stroke. J Neurol Neurosurg Psychiatry 73:17–20

    Article  PubMed  CAS  Google Scholar 

  30. Gerriets T, Stolz E, Konig S et al (2001) Sonographic monitoring of midline shift in space-occupying stroke: an early outcome predictor. Stroke 32:442–447

    Article  PubMed  CAS  Google Scholar 

  31. Griewing B, Motsch L, Piek J et al (1998) Transcranial power mode Doppler duplex sonography of intracranial aneurysms. J Neuroimaging 8:155–158

    PubMed  CAS  Google Scholar 

  32. Grosset DG, Straiton J, Mcdonald I et al (1993) Use of transcranial Doppler sonography to predict development of a delayed ischemic deficit after subarachnoid hemorrhage. J Neurosurg 78:183–187

    Article  PubMed  CAS  Google Scholar 

  33. Harrer JU, Tsivgoulis G (2011) Transcranial sonography for monitoring hydrocephalus: an underestimated imaging modality. Neurology 76:852–853

    Article  PubMed  Google Scholar 

  34. Ionita CC, Graffagnino C, Alexander MJ et al (2008) The value of CT angiography and transcranial doppler sonography in triaging suspected cerebral vasospasm in SAH prior to endovascular therapy. Neurocrit Care 9:8–12

    Article  PubMed  Google Scholar 

  35. Jahromi AS, Cina CS, Liu Y et al (2005) Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg 41:962–972

    Article  PubMed  Google Scholar 

  36. Kiphuth IC, Huttner HB, Struffert T et al (2011) Sonographic monitoring of ventricle enlargement in posthemorrhagic hydrocephalus. Neurology 76:858–862

    Article  PubMed  CAS  Google Scholar 

  37. Krejza J, Mariak Z, Walecki J (1999) Usefulness of transcranial color-coded sonography in the diagnosis of cerebral vasospasm. Stroke 30:2240–2241

    Article  PubMed  CAS  Google Scholar 

  38. Lavinio A, Schmidt EA, Haubrich C et al (2007) Noninvasive evaluation of dynamic cerebrovascular autoregulation using Finapres plethysmograph and transcranial Doppler. Stroke 38:402–404

    Article  PubMed  Google Scholar 

  39. Lindegaard KF, Nornes H, Bakke SJ et al (1988) Cerebral vasospasm after subarachnoid haemorrhage investigated by means of transcranial Doppler ultrasound. Acta Neurochir Suppl (Wien) 42:81–84

    Article  Google Scholar 

  40. Markus HS, Droste DW, Kaps M et al (2005) Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 111:2233–2240

    Article  PubMed  CAS  Google Scholar 

  41. Markus HS, Harrison MJ (1992) Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke 23:668–673

    Article  PubMed  CAS  Google Scholar 

  42. Markus HS, King A, Shipley M et al (2010) Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study. Lancet Neurol 9:663–671

    Article  PubMed  Google Scholar 

  43. Markus HS, Tegeler CH (1995) Experimental aspects of high-intensity transient signals in the detection of emboli. J Clin Ultrasound 23:81–87

    Article  PubMed  CAS  Google Scholar 

  44. Meairs S, Culp W (2009) Microbubbles for thrombolysis of acute ischemic stroke. Cerebrovascular diseases 27(Suppl 2):55–65

    Article  PubMed  Google Scholar 

  45. Molina CA, Ribo M, Rubiera M et al (2006) Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke 37:425–429

    Article  PubMed  CAS  Google Scholar 

  46. Monteiro LM, Bollen CW, Van Huffelen AC et al (2006) Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis. Intensive Care Med 32:1937–1944

    Article  PubMed  Google Scholar 

  47. Moskowitz SI, Davros WJ, Kelly ME et al (2010) Cumulative radiation dose during hospitalization for aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol 31:1377–1382

    Article  PubMed  CAS  Google Scholar 

  48. Muller M, Schimrigk K (1996) Vasomotor reactivity and pattern of collateral blood flow in severe occlusive carotid artery disease. Stroke 27:296–299

    Article  PubMed  CAS  Google Scholar 

  49. Nedelmann M, Gerriets T, Kaps M (2008) Therapeutic ultrasound of acute cerebral artery occlusion. Nervenarzt 79:1399–1400, 1402–1396

    Article  PubMed  CAS  Google Scholar 

  50. Nedelmann M, Stolz E, Gerriets T et al (2009) Consensus recommendations for transcranial color-coded duplex sonography for the assessment of intracranial arteries in clinical trials on acute stroke. Stroke 40:3238–3244

    Article  PubMed  Google Scholar 

  51. Nederkoorn PJ, Van Der Graaf Y, Hunink MG (2003) Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 34:1324–1332

    Article  PubMed  Google Scholar 

  52. Ng PP, Higashida RT, Cullen SP et al (2004) Intraarterial thrombolysis trials in acute ischemic stroke. J Vasc Interv Radiol 15:77–85

    Article  Google Scholar 

  53. Piepgras A, Schmiedek P, Leinsinger G et al (1990) A simple test to assess cerebrovascular reserve capacity using transcranial Doppler sonography and acetazolamide. Stroke 21:1306–1311

    Article  PubMed  CAS  Google Scholar 

  54. Postert T, Braun B, Meves S et al (1999) Contrast-enhanced transcranial color-coded sonography in acute hemispheric brain infarction. Stroke 30:1819–1826

    Article  PubMed  CAS  Google Scholar 

  55. Ringelstein EB, Droste DW, Babikian VL et al (1998) Consensus on microembolus detection by TCD. International Consensus Group on Microembolus Detection. Stroke 29:725–729

    Article  PubMed  CAS  Google Scholar 

  56. Ringelstein EB, Sievers C, Ecker S et al (1988) Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions. Stroke 19:963–969

    Article  PubMed  CAS  Google Scholar 

  57. Ritter MA, Dittrich R, Thoenissen N et al (2008) Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. A systematic review of the literature. J Neurol 255:953–961

    Article  PubMed  Google Scholar 

  58. Rodallec MH, Marteau V, Gerber S et al (2008) Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics 28:1711–1728

    Article  PubMed  Google Scholar 

  59. Romano JG, Rabinstein AA, Arheart KL et al (2008) Microemboli in aneurysmal subarachnoid hemorrhage. J Neuroimaging 18:396–401

    Article  PubMed  Google Scholar 

  60. Schmiedek P, Piepgras A, Leinsinger G et al (1994) Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 81:236–244

    Article  PubMed  CAS  Google Scholar 

  61. Seidel G, Kaps M, Dorndorf W (1993) Transcranial color-coded duplex sonography of intracerebral hematomas in adults. Stroke 24:1519–1527

    Article  PubMed  CAS  Google Scholar 

  62. Seidel G, Kaps M, Gerriets T et al (1995) Evaluation of the ventricular system in adults by transcranial duplex sonography. J Neuroimaging 5:105–108

    PubMed  CAS  Google Scholar 

  63. Turner CL, Higgins JN, Gholkar A et al (2005) Intracranial aneurysms treated with endovascular coils: detection of recurrences using unenhanced and contrast-enhanced transcranial color-coded duplex sonography. Stroke 36:2654–2659

    Article  PubMed  Google Scholar 

  64. Vernieri F, Pasqualetti P, Matteis M et al (2001) Effect of collateral blood flow and cerebral vasomotor reactivity on the outcome of carotid artery occlusion. Stroke 32:1552–1558

    Article  PubMed  CAS  Google Scholar 

  65. Waydhas C (1999) Intrahospital transport of critically ill patients. Crit Care 3:R83–89

    Article  PubMed  CAS  Google Scholar 

  66. Weyer GW, Nolan CP, Macdonald RL (2006) Evidence-based cerebral vasospasm management. Neurosurg Focus 21:E8

    Article  PubMed  Google Scholar 

  67. White H, Venkatesh B (2006) Applications of transcranial Doppler in the ICU: a review. Intensive Care Med 32:981–994

    Article  PubMed  Google Scholar 

  68. White PM, Wardlaw JM, Teasdale E et al (2001) Power transcranial Doppler ultrasound in the detection of intracranial aneurysms. Stroke 32:1291–1297

    Article  PubMed  CAS  Google Scholar 

  69. Willie CK, Colino FL, Bailey DM et al (2011) Utility of transcranial Doppler ultrasound for the integrative assessment of cerebrovascular function. J Neurosci Methods 196:221–237

    Article  PubMed  CAS  Google Scholar 

  70. Wong KS, Chen C, Fu J et al (2010) Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 9:489–497

    Article  PubMed  CAS  Google Scholar 

  71. Wunderlich MT, Goertler M, Postert T et al (2007) Recanalization after intravenous thrombolysis: does a recanalization time window exist? Neurology 68:1364–1368

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Neurologie des MVZ, CaritasKlinikum St. Theresia, Rheinstraße 2, 66113, Saarbrücken, Deutschland

    J.U. Harrer

  2. Klinik für Neurologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland

    J.U. Harrer

  3. Klinik für Neurologie, Universitätsklinikum Gießen und Marburg, Gießen, Deutschland

    M. Nedelmann

  4. Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Deutschland

    J. Eyding

  5. Klinik für Neurologie, Universitätsklinikum Münster, Münster, Deutschland

    M. Ritter

  6. Klinik für Neurologie, Universitätsmedizin Greifswald, Greifswald, Deutschland

    U. Schminke

  7. Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Städtisches Klinikum München-Harlaching, München, Deutschland

    G. Schulte-Altedorneburg

  8. Klinik für Neurologie, Universitätsklinikum Erlangen, Erlangen, Deutschland

    M. Köhrmann

  9. Klinik für Neurologie, Universität Regensburg, Bezirksklinikum Regensburg, Regensburg, Deutschland

    F. Schlachetzki

Authors
  1. J.U. Harrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Nedelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Eyding
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Ritter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Schminke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Schulte-Altedorneburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Köhrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Schlachetzki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.U. Harrer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Harrer, J., Nedelmann, M., Eyding, J. et al. Sonographische Diagnostik in der neurologischen Notfall- und Intensivmedizin. Med Klin Intensivmed Notfmed 108, 131–138 (2013). https://doi.org/10.1007/s00063-012-0146-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-012-0146-6

Schlüsselwörter

Keywords

Search

Navigation