scholarly journals Predictive value of transcranial doppler ultrasound for cerebral small vessel disease in elderly patients

2019 ◽  
Vol 77 (5) ◽  
pp. 310-314 ◽  
Author(s):  
Shengqi Fu ◽  
Jiewen Zhang ◽  
Hongtao Zhang ◽  
Shuling Zhang
Keyword(s):  
Elderly Patients ◽  
Transcranial Doppler ◽  
Pulsatility Index ◽  
Small Vessel Disease ◽  
Univariate Analysis ◽  
Transcranial Doppler Ultrasound ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Mean Flow ◽  
Vessel Disease

ABSTRACT Objective: To investigate the predictive value of transcranial Doppler (TCD) ultrasound for cerebral small vessel disease in elderly patients. Methods: Transcranial Doppler ultrasound and magnetic resonance imaging (MRI) were performed on 184 elderly patients with cerebral small vessel disease. The relationship of clinical characteristics and TCD ultrasound parameters with severe white matter lesions (WMLs) in MRI were investigated by univariate analysis and multivariate analysis. Results: The univariate analysis showed that age, left middle cerebral artery (MCA) mean flow velocity, right MCA mean flow velocity and mean MCA pulsatility index were significantly correlated with severe WMLs (p < 0.05). The multivariate logistic regression analysis showed that only age (odds ratio: 1.21; 95%CI: 1.10–1.36; p < 0.01) and MCA pulsatility index (dominance ratio: 1.13; 95%CI: 1.06–1.80; p = 0.02) were significantly correlated with severe WMLs. The analysis of TCD ultrasound parameters showed that when the cut-off for MCA pulsatility index was 1.04, it could identify severe WMLs. The area under the curve was 0.70 (95%CI: 0.60–0.80). The sensitivity and specificity were 63.0% and 72.0%, respectively. The positive and negative predictive values were 35.4% and 86.6%, respectively. Conclusion: The MCA pulsatility index in TCD ultrasound is significantly correlated with severe WMLs; and TCD ultrasound can guide selective MRI for the detection of WMLs.

TCD-Profiling Using AVERAGE. A New Technique to Evaluate Transcranial Doppler Ultrasound Flow Spectra of Subjects with Cerebral Small Vessel Disease

2015 ◽  
Vol 41 (1-2) ◽  
pp. 50-59 ◽  
Author(s):  
Anna Lena Fisse ◽  
Johannes Pueschel ◽  
Michael Deppe ◽  
E. Bernd Ringelstein ◽  
Martin A. Ritter
Keyword(s):  
Doppler Ultrasound ◽  
Validation Study ◽  
Transcranial Doppler ◽  
Small Vessel Disease ◽  
Transcranial Doppler Ultrasound ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
New Technique ◽  
Healthy Controls ◽  
Vessel Disease

Background: There is an unmet need for screening methods to detect and quantify cerebral small vessel disease (SVD). Transcranial Doppler ultrasound (TCD) flow spectra of the larger intracranial arteries probably contain relevant information about the microcirculation. However, it has not yet been possible to exploit this information as a valuable biomarker. Methods: We developed a technique to generate normalized and averaged flow spectra during middle cerebral artery Doppler ultrasound examinations. Second, acceleration curves were calculated, and the absolute amount of the maximum positive and negative acceleration was calculated. Findings were termed ‘TCD-profiling coefficient' (TPC). Validation study: we applied this noninvasive method to 5 young adults for reproducibility. Degenerative microangiopathy study: we also tested this new technique in 30 elderly subjects: 15 free of symptoms but with MRI-verified presence of cerebral SVD, and 15 healthy controls. SVD severity was graded according to a predefined score. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) study: TPC values of 10 CADASIL patients were compared with those of 10 healthy controls. Pulse wave analysis and local measurements of carotid stiffness were also performed. CADASIL patients were tested for cognitive impairment with the Montreal Cognitive Assessment scale. White matter and basal ganglia lesions in their cerebral MRI were evaluated according to the Wahlund score. Results: Validation study: the technique delivered reproducible results. Degenerative microangiopathy study: patients with SVD had significantly larger TPCs compared with controls (SVD: 2,132; IQR 1,960-2,343 %/s vs. controls: 1,935; IQR 1,782-2,050 %/s, p = 0.01). TPC values of subjects with SVD significantly correlated with SVD severity scores (R = 0.58, n = 15, p < 0.05). CADASIL study: TPC values of CADASIL patients were significantly higher than values of the controls (CADASIL: 2,504; IQR 2,308-2,930 %/s vs. controls 2,084; 1,839-2,241 %/s, p = 0.008), and also significantly higher than the TPC values of the patients with SVD from the degenerative microangiopathy study (p = 0.007). CADASIL patients had significantly worse cognitive test results than healthy controls. Conclusion: TCD-profiling detects impairment of the cerebral microcirculatory state. The suitability of the TCD-profiling for the evaluation of cerebral microangiopathy was confirmed.

scholarly journals Transcranial Doppler Ultrasound for Screening Cerebral Small Vessel Disease

Stroke ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 2791-2793 ◽  
Author(s):  
Vincent Mok ◽  
Ding Ding ◽  
Jianhui Fu ◽  
Yunyun Xiong ◽  
Winnie W.C. Chu ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Small Vessel Disease ◽  
Transcranial Doppler Ultrasound ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease

scholarly journals Spatial Navigation Is Impaired in Elderly Patients With Cerebral Small Vessel Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Hóngyi Zhào ◽  
Liyi Chi ◽  
Yanhai Zhang ◽  
Yonghua Huang ◽  
Hongyan Tian
Keyword(s):  
Elderly Patients ◽  
Small Vessel Disease ◽  
Spatial Navigation ◽  
Linear Regression Analysis ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Clock Drawing Test ◽  
Vessel Disease ◽  
Trail Making ◽  
Fazekas Scale

Cerebral small vessel disease (SVD) refers to a heterogeneous group of pathological processes that result from damage to the small penetrating vessels in the brain. Spatial navigation, one of the most fundamental behaviors, has lately attracted considerable clinical interest. This study aimed to determine whether spatial navigation performance is impaired in elderly SVD patients. In total, 18 elderly patients with severe SVD, 40 elderly patients with non-severe SVD, and 41 age-matched healthy volunteers were classified according to the Fazekas scale. Spatial navigation was evaluated by Amunet (a computer-based analogy of Morris water maze software), and a mini-mental scale evaluation (MMSE), animal category verbal fluency test (VFT), clock drawing test (CDT), and trail making test (TMT) -B were also applied. Compared to healthy controls, severe SVD, rather than non-severe SVD patients, exhibited significantly worse performance on “allocentric + egocentric” (41.74 ± 29.10 vs. 31.50 ± 16.47 vs. 29.21 ± 19.03; p = 0.031). Furthermore, the different abilities of spatial navigation among groups reached a statistical level on allocentric subtests (46.93 ± 31.27 vs. 43.69 ± 23.95 vs. 28.56 ± 16.38; p = 0.003), but not on egocentric subtest (56.16 ± 39.85 vs. 56.00 ± 28.81 vs. 43.06 ± 25.07; p = 0.105). The linear regression analysis revealed that allocentric navigation deficit was significantly correlated with TMT-B (p = 0.000, standardized β = 0.342) and VFT (p = 0.016, standardized β = −0.873) performance in elderly SVD patients. These results elucidated that spatial navigation ability could be a manifestation of cognitive deficits in elderly patients with SVD.

Transcranial Doppler assessment of patients with cerebral small vessel disease

2019 ◽  
Vol 2 (1) ◽  
pp. 75
Author(s):  
AlaaEbrahim Ata Ata Shaaban ◽  
MahmoudH Ebrahim ◽  
SalmaH M. Khalil ◽  
MohamedM T. Elbaghdady
Keyword(s):  
Transcranial Doppler ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease

scholarly journals Association among Parkinsonism-related motor complaints, cerebral small vessel disease, and cerebrovascular risk factors in a community-dwelling population

2019 ◽  
Author(s):  
Yang Guo ◽  
Cai-hong Ji ◽  
Fei Han ◽  
Jiang-tao Zhang ◽  
Fei-fei Zhai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Small Vessel Disease ◽  
Univariate Analysis ◽  
The Elderly ◽  
Cerebral Small Vessel Disease ◽  
Community Dwelling ◽  
Small Vessel ◽  
Vessel Disease ◽  
Cerebrovascular Risk Factors ◽  
Cerebrovascular Risk

Abstract Background Parkinsonism-related motor complaints are commonly seen in the elderly. Our study aimed to investigate the association among Parkinsonism-related motor complaints, cerebral small vessel disease and cerebrovascular risk factors in a community-dwelling population in a Chinese rural area.Methods Individuals who were 50 years old or older, were independently living, were well-functioning, and had no history of ischemic or hemorrhagic stroke, were included. Brain magnetic resonance imaging (MRI), quantified motor function assessment, and questionnaire screening for Parkinsonism-related motor complaints were performed. Clinical data including cerebrovascular risk factors were collected. In univariate analysis, Chi-square test and student t-test were used to compare dichotomous variables and continuous variables, respectively, between individuals with or without motor complaints. In multivariate analysis, binary Logistic regression models were generated to determine risk factors for Parkinsonism-related motor complaints. General linear models were used to compare motor parameters between individuals with or without motor complaints. Results In the final analysis, 854 people were included. Individuals with motor complaints had a longer time for finger taping (6.2s v.s. 5.6s, p = 0.006), and a longer time for 3m-walking(4.0s v.s. 3.6s, p = 0.034) than did those without motor complaints. Hypertension was associated with motor complaints (odds ratio, 1.82; 95% confidence interval [CI], [1.21, 2.73]; p = 0.004). Age was not associated with motor complaints; none of the neuroimaging markers of cerebral small vessel disease was associated with motor complaints. Conclusion Hypertension is associated with Parkinsonism-related motor complaints. Better management of hypertension may prevent mobility limitation in the elderly. The questionnaire that we used for Parkinsonism is not suitable for screening small vessel disease in a community-dwelling population.

Abstract TP472: The Interplay Between Subclinical Micro- and Macro-Vascular Disease in Asymptomatic Individuals

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ezgi Yetim ◽  
Ethem M Arsava ◽  
Kader K Oguz ◽  
Mehmet A Topcuoglu
Keyword(s):  
Basal Ganglia ◽  
Vascular Disease ◽  
Pulsatility Index ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Multivariate Models ◽  
Large Arteries ◽  
Vessel Disease ◽  
Carotid Distensibility

Introduction: Pathophysiological changes within large arteries, among many other factors, are considered to contribute to cerebral small vessel disease. Craniocervical sonography is a valuable tool in this regard to evaluate various physiological metrics of extra- and intra-cranial large arteries. Herein, we tried to evaluate the interplay between markers of small vessel disease, and internal carotid (ICA) and middle cerebral artery (MCA) pulsatility, carotid distensibility and intima media thickness (IMT). Methods: We prospectively evaluated a total of 278 subjects without any prior history of stroke using transcranial and cervical Doppler ultrasound, and magnetic resonance imaging. Pulsatility index was determined by Gosling’s index from bilateral MCA’s and ICA’s. We also measured carotid distensibility and IMT (by AutoIMT TM ) from both carotids and calculated their mean values. The relationship of all these sonographic metrics with imaging markers of chronic small vessel disease [lacunes, microbleeds, perivascular spaces (PVS), white matter hyperintensities (WMH)] were evaluated in multivariate models where age and cardiovascular risk factors were included as additional covariates. Results: The study population consisted of 108 males and 170 females with a mean±SD age of 64±9 years. In bivariate analyses, higher carotid IMT, higher MCA and ICA pulsatility indices, and lower carotid distensibility were significantly associated with high burden of WMH (Fazekas score of ≥2), basal ganglia PVS (PVS score ≥2) and presence of lacunes, but not with microbleeds or centrum semiovale PVS. In multivariate models, each 0.1 mm change in IMT increased the odds of severe WHM by 1.4 (95%CI 1.0-1.9), severe basal ganglia PVS by 1.4 (1.0-1.8) and lacunes by 1.6 (1.0-2.6), while no significant association remained for pulsatility index or distensibility. Conclusion: Our analyses highlight that IMT, is not only a subclinical marker of atherosclerosis, but also emerges as a factor intimately related with cerebral small vessel disease. These findings raise the possibility that IMT and cerebral small vessel disease might together reflect downstream events that culminate in vascular disease involving the large and small vessels of the brain.

scholarly journals Prevalence of Microembolic Signals in Embolic Stroke of Undetermined Source and Other Subtypes of Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 655-658 ◽  
Author(s):  
Eiko Higuchi ◽  
Sono Toi ◽  
Yuka Shirai ◽  
Takao Hoshino ◽  
Kentaro Ishizuka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Small Vessel Disease ◽  
Univariate Analysis ◽  
Cerebral Small Vessel Disease ◽  
Embolic Stroke ◽  
Small Vessel ◽  
Large Artery ◽  
Vessel Disease ◽  
Ischemic Attack

Background and Purpose— Embolic stroke of undetermined source (ESUS) has been proposed to cause thromboembolic infarction from unknown but potential embolic sources. However, an embolus remains undetected in ESUS. The goal of this study was to characterize the prevalence and risk factors of microembolic signals (MESs) in ESUS. Methods— We examined 108 patients with acute ischemic stroke in the internal carotid artery territory or transient ischemic attack within 14 days of symptom onset and who were admitted to our hospital between April 2017 and March 2019. MESs were monitored in the middle cerebral artery on transcranial Doppler for 60 minutes. We examined the prevalence and number of MES in ESUS and other stroke subtypes, such as cardioembolism, large artery atherosclerosis, cerebral small vessel disease, and transient ischemic attack. The present study was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000031913). Results— MESs were detected in 33 (31%) of 108 patients. ESUS showed the highest proportion (12/24 [50%]), followed by large artery atherosclerosis (8/20 [40%]), cardioembolism (6/18 [33%]), transient ischemic attack (4/24 [17%]), and cerebral small vessel disease (3/21 [14%]). Univariate analysis showed that higher systolic blood pressure, body mass index, hemoglobin A1c, and ESUS were significantly associated with MES. In multiple logistic regression analysis, ESUS remained significantly associated with MES after adjustment for described covariates from univariate analysis (odds ratio, 2.86 [95% CI, 1.01–8.08]). Conclusions— This study demonstrated significant association of ESUS with MES, supporting the embolic nature of this stroke subtype. Registration— URL: https://upload.umin.ac.jp . Unique identifier: UMIN000031913.

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