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Stroke and Right-to-Left Shunt in ICU: Role of the Transcranial Doppler (TCD/TCCS)

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Neurosonology in Critical Care

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Abstract

The detection of right-to-left shunt and patent foramen ovale is a frequent medical question for several specialists, including neurologists, cardiologists, and anesthesiologists. Paradoxical embolism could be indeed responsible for stroke and for signs and symptoms of decompression sickness in divers and in high altitude pilots. The techniques aimed at this diagnosis are transcranial Doppler and echocardiography, with saline contrast agents. Transesophageal echocardiography, considered the gold standard for the morphological diagnosis, is invasive and cannot be performed as a routine screening method, while transcranial Doppler has a very high sensitivity for the shunt detection, even higher than trans-thoracic echocardiography, with the capability of easily given objective measures for the shunt quantification. Transcranial Doppler technique and protocols will be described in this review, with several methodological aspects and clinical considerations.

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Authors and Affiliations

  1. Department of Neurosciences and Mental Health, Neurosonology, Sapienza, University of Rome, Rome, Italy

    Edoardo Vicenzini & Chiara Izzo

  2. Member - ESNCH, Oslo, Norway

    Edoardo Vicenzini

Authors
  1. Edoardo Vicenzini
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  2. Chiara Izzo
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Correspondence to Edoardo Vicenzini .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Buenos Aires, Buenos Aires, Argentina

    Camilo N. Rodríguez

  2. Stroke Unit & Neurosonology Lab, University of Padua School of Medicine, Padova, Italy

    Claudio Baracchini

  3. Department of Critical Care and Anesthesiology, Fundación Valle del Lili, Cali, Colombia

    Jorge H. Mejia-Mantilla

  4. Department of Clinical Neurosciences Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK

    Marek Czosnyka

  5. Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I Suarez

  6. President of Hungarian Neurological Society, Department of Neurology, Clinical Center Debrecen University, Debrecen, Hungary

    László Csiba

  7. Intensive Care Unit, Clinics Hospital, Universidad de la Republica School of Medicine, Montevideo, Uruguay

    Corina Puppo

  8. Center for Neurological Vascular Diagnostics, Munich, Germany

    Eva Bartels

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Vicenzini, E., Izzo, C. (2022). Stroke and Right-to-Left Shunt in ICU: Role of the Transcranial Doppler (TCD/TCCS). In: Rodríguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_37

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  • DOI: https://doi.org/10.1007/978-3-030-81419-9_37

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-81419-9

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