DOPPLEROGRAPHIC CHARACTERISTIC OF EXTRA-AND-INTRACRANIAL
|
|
- Marjorie Gilmore
- 5 years ago
- Views:
Transcription
1 Open Access Research Journal Medical and Health Science Journal, MHSJ ISSN: (Print) (Online) Volume 6, 2011, pp DOPPLEROGRAPHIC CHARACTERISTIC OF EXTRA-AND-INTRACRANIAL HEMODYNAMICS OF THE ACUTE CEREBRAL INFARCTION The paper studies the characteristics of cerebral hemodynamic in patients with acute ischemic stroke using ultrasound diagnostics (dopplerography). It is shown that cerebral atherosclerotic genesis in patients occurs with the dominated diffuse decrease of cerebral hemodynamics and increased rigidity and vascular tone in carotid and extracranial vessels. Significant predominance of cerebral vessels occlusion, with appearances of average angiospasm and asymmetric blood flown in intracranial cerebral vessels, was found among patients with hypertension genesis. SHERZOD DUSCHANOV Department of Nervous Diseases Urgench branch of Tashkent Medical Academy, Uzbekistan Keywords: Extra-and-intracranial hemodynamics, acute stroke, dopplerographic characteristics. UDC: Introduction The problem of the present-day pathogenic therapy of the acute cerebral blood flow disturbance is the most important in the clinical neurology due to high level of prevalence, lethality, disability and social adaptation of people affected by the cerebral infarction (Vereschagin and Piradov, 1999; Yahno and Vilenskiy, 2005). Brain is the main organ affected by the diseases of different etiology connected with cerebral and vascular complications (Gusev and Skvortsova, 2001). Cerebral infarction happens as aftereffect of different pathological processes the main of which are arteriosclerosis and arterial hypertension (Skvortsova et al., 2006; Pokrovskiy, 1992; Myasnikov, 1965; Barhatov et al., 2006). Prognosis of peculiarities in disease dynamics and result of the acute cerebral blood flow disturbance can be of decisive importance in choosing of the first aid and secondary medical treatment (Shnaider and Vinogradova, 2003; Skvortsova, 2001). Complexity and multiple factors of development of ischemic infarctions stipulates the necessity of complex study of some aspects of their pathogenesis (Skvortsova, 2001). Disturbance of hemodynamic is an important issue in pathogenesis, clinical course and development of complications under the acute cerebral circulation disturbances (Skvortsova, 2001; Pavlovskaya, 1978). Progressive increase of numbers of cerebral infarction and its rejuvenation results from the increase of arterial hypertension and atherosclerosis which are the key factors of pathogenesis of acute cerebral circulation development. It is quite vividly nowadays that pathological organic affection of vascular wall goes in line with malfunction of hemodynamic in great vessels of the brain (Belkin et al., 2006; Gaidar et al., 2008; Yahno and Shtulman, 2003). Due to the abovementioned, the goal of the current research is studying of peculiarities of cerebral hemodynamic under the acute ischemic disturbances of the cerebral blood circulation in case of the atherosclerosis and hypertension. Data and methods of the research 100 patients with cerebral infarctions of hemisphere localization have been examined, acute cerebral blood flow disturbance (ACBFD) of atherosclerotic nature appeared as 35% and ACBFD of atherosclerotic and hypertension combination as 65%; 30 patients were included into the screening group. 41 patients had ischemic stroke in the area of the right medial cerebral artery and 59 in the area of the left medial cerebral artery. The
2 ischemic infarction patients consisted of 60 men and 40 women, the average age of the patients was 61.4±3.1. The average age of the screening group was 49±4.8. All of the patients with the acute cerebral blood flow disturbance received the homogeneous basic undifferentiated and differentiated treatment of ACBFD. Undifferentiated therapy included dehydratation by means of the loop diuretics (furosemide) and/or osmotic diuretics (glycerin), antihypertensive therapy (inhibitors of angiotensin-converting enzyme, calcium channel inhibitors), cardio-vascular medicine (electrolytes, cardiac glycoside), spasmolytic medicine (magnesium sulphate), antihypertensive medicine and antioxidants. Differentiated therapy of ischemic infarctions was directed into renewal of cerebral circulation (cavinton, pentoxifilin), improvement of rheological characteristic of blood (heparin, pentocsifilin) and others. Condition of patients severity was evaluated based on two clinical scales - NIH Stroke Scale (Goldstein et al., 1989) and Scandinavian one (Scandinavian Stroke Study Group, 1985). Research doesn t cover cases of high severity, in accordance with NIHSS clinical scales (not more than 29 scores) and Scandinavian scale (not less than 11 scores). All patients underwent ultrasonic and dopplerography of brachycephalic trunk examination (UDBT) of common carotid artery (CCA), internal carotid artery (ICA) and supratrochlear artery, including transcranial dopplerography examination (as well as study of hemodynamic of medium cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) by using LOGIDOP-4 device (made by Kransbuchler, Germany) equipped with 2.4 and 8 MHz sensor identifying linear and average blood circulation velocity, and Purselo (RI) and Gosling (PI) indexes. Evaluation of extracranial sectors of carotid artery was carried out by means of functional test - carotid compression test. Research results The main neurological occurrence of ischemic hemisphere infarction have been characterized by the prevailed focal signs: central paralysis of the VIIth and XIIth nerves, mono- and hemiparesis or hemiplegia, occurrence of pathological reflexes, reflexes of oral automatism in combination with sensitivity disorders in form of surface or total monoand hemianesthesia. Affection of dominating hemisphere was accompanied by disorder of higher cortical functions. The average clinical score under the registration of patients with cerebral infarctions appeared as 20.4±1.7 based on NIHSS scale and 27.8±2.3 as per the Scandinavian one, what is in both cases the moderated severe level of the disease. Studying of the age and sexual structure of the disease demonstrates that acute cerebral blood flow disturbance (ACBFD) of atherosclerotic nature affects more the old men, and ACBFD of the hypertensive nature affects the young men and women. Ultrasonic examination of carotid extracranial arteries showed stenotic lesion prevailing within the internal carotid artery (ICA), atherosclerotic changing of the curve, vasomotor spasm symptoms and decline in vessels reactivity. Signs of the internal carotid artery stenosis included: increase of the blood flow velocity in bifurcation area; presence of turbulent blood flow; decline in blood flow velocity in common and/or internal carotid artery by 30% and more in comparison with contralateral arteries; decrease of diastolic component of the blood flow velocity in the common carotid artery (CCA) in comparison with contralateral part; 40% decrease in blood flow velocity in supratrochlear artery and more in comparison with contralateral part; appearance of the retrograde blood flow in supratrochlear artery under the compression of 1-2 with homolateral common carotid artery; blood flow velocity decrease in supratrochlear artery under the compression of homolateral and/or superficial temporal artery; no decrease of blood flow velocity in supratrochlear artery under the carrying out of superciliary test of hemodynamics; no change of blood flow velocity in supratrochlear artery under the compression of homolateral superficial temporal or facial artery under the blood flow
3 increase reaction in contralateral artery during the compression of these arteries at the similar side; changing of spectral characteristic of blood flow in carotid artery. Ultrasonic and Dopplerography examination of carotid braheocephalous vessels demonstrated diversified Ultrasonic and Dopplerographic results and was specific for each of the examined groups of the patients (Table 1). TABLE 1. DOPPLEROGRAPHIC PERFORMANCES OF EXTRACRANIAL HEMODYNAMIC OF THE EXAMINED PATIENTS The examined groups Artery Parameters GS. cm/sec PI RI CCA 88.3± ± ±0.17 Screening group ICA 78.4± ± ±0.23 (n=30) SA (supratrochlear artery) 54.5± ± ±0.15 Atherosclerotic stroke (n=35) Combination of atherosclerosis and hypertension (n=65) CCA 65.6±4.2* 2.49±0.40* 1.25±0.22* ICA 51.8±3.98* 2.14±0.30* 1.26±0.22* SA 30.8±4.8* 1.62±0.32* 1.05±0.19 CCA 60.4±5.4* 2.53±0.43* 1.28±0.25* ICA 45.6±5.7* 2.18±0.27* 1.30±0.25* SA 27.6±4.1** 1.69±0.35* 1.17±0.21* Note: reliability of performances in regards to the norm was noted: *- (Р<0.05); **- (Р<0.01); Atherosclerotic ACBFD have been accompanied by the diffuse atherosclerotic changing of CCA and ICA dopplerographic curve with the considerable reduce of linear blood flow velocity level, increase of rigidity of vessel wall. In this group of patients the stenotic changes of vessels walls in most cases happened both in CCA and ICA. Stenosis reached critical rate in 28.6% of the cases % of patients with atherosclerotic ACBFD had low reactivity of the vessels during the compression test. Decrease of linear blood flow velocity by more than 30% was found in 23 of 35 cases, CCA, ICA and supratrochlear artery were affected at most of the patients. 8.57% of the patients had retrograde blood flow, and 34.28% had antegrade blood flow changed into the retrograde one in response to the compression test. It was noted that quite often in this group (40.0% of the patients) higher stenosis of extracranial carotid trunks was more at the opposite side from the affected hemisphere. This group of the examined patients had a statistically significant increase of Purselo (more than by 40%) and Gosling (more that by 70%) coefficients, what evidenced the increase of resistance in regards to the blood flow and increase of the periphery resistance and brachycephalic trunk rigidity. Under the combination of atherosclerosis and hypertension at the acute cerebral blood flow disturbance, the ultrasonic and Doppler examination demonstrated the early stenotic changes which were often located within the internal carotid artery, prevailing from one of the sides and accompanying with a moderate two-sided vasomotor spasm. This group more often included hemodynamic stenosis leading to the occlusion of extracranial carotid brachiocephalic trunk. Reactivity of vessels in this group of patients was in most cases lowered. Retrograded blood flow in supratrochlear artery was recorded in 20% of the studied cases, and in 60% of the studied cases the antegrade blood flow after the compressive test changed in the retrograded direction with the significant hemodynamic decrease of blood flow velocity in supratrochlear artery and moderate increase of the vascular tone. Here is the clinical observation. Patient named B., 60 years old. Diagnosis: Cerebral vascular disease. The acute disturbance of cerebral blood flow of ischemic nature, in medium cerebral artery of the right hemisphere with left-sided hemisyndrome developed as a result of atherosclerosis of cerebral vessels and hypertension. Patient was hospitalized to the department of intensive neurology. He complained of a weakness and numbness in left extremities, headache and giddiness
4 Impartial observations: systolic noise over the carotid arteries from both sides was auscultated. Results of dopplerographic examination: Retrograded blood flow in supratrochlear artery was recorded; it was disappearing under the compression of homolateral CCA. Under the compression of homolateral surface of temporal artery blood flow partially reduces. Linear blood flow velocity in the left ICA is significantly intensified up to 250 cm/sec, it was impossible to check condition in ICA on the right. Periphery type of curve was recorded in the common carotid arteries. Blood flow is aggravated in vertebral arteries from both sides and the main artery, what evidences the compensation of blood circulation by means of carotid arteries and system of vertebral arteries. The velocity of blood flow in the right MCA is increased by 34cm/sec and in the left СМА by 40 cm/sec. Blood flow in the anterior cerebral artery from both sides was not subject to location detection. An intensive blood flow is recorded in posterior cerebral artery and it becomes more intensive under the compression of homolateral MCA. Based on the above mentioned conclusion was made as follows: signs of occlusion of the right ICA; hemodynamically important stenosis of the left ICA. Diagnosis was confirmed after the angiography. Source of the collateral blood flow: it was originated from the vertebral basilar system and extra and intracranial anastomosis through the eye artery. FIGURE 1. PATIENT B. RETROGRADE TYPE OF BLOOD FLOW IN THE RIGHT SUPRATROCHLEAR ARTERY FIGURE 2. PATIENT B. PERIPHERAL TYPE OF CURVE IN THE COMMON CAROTID ARTERIES
5 FIGURE 3. PATIENT B. STENOSIS OF THE LEFT INTERNAL CAROTID ARTERY Studying of the intracranial hemodynamics demonstrated that in case of atherosclerotic cerebral hemisphere stroke the dominating indicators include reduction of perfusion of the medium cerebral artery accompanied with rigidity growth of the vessel wall, and increase of the linear blood flow velocity in homolateral anterior cerebral artery, what is the sign of stenosis of segments of medium cerebral artery (sometimes with the similar increase of linear blood flow velocity in posterior cerebral artery). A significant factor (p<0.05) in this group of patients was also reduction of perfusion in carotid arteries of the opposite cerebral hemisphere. Presence of symmetrical and asymmetrical arterial flow and symptoms of labored perfusion against the background of peripheral vasoconstriction and arteriolosclerosis was recorded as 17.14% of atherosclerotic ACBFD (Table 2). TABLE 2. DOPPLEROGRAPHIC PERFORMANCES OF EXTRACRANIAL HEMODYNAMIC OF THE EXAMINED PATIENTS The examined groups Artery Parameters GS. cm/sec PI RI MCA 85.5± ± ±0.12 Screening group ACA 70.6± ± ±0.15 (n=30) PCA 60.4± ± ±0.18 Atherosclerotic stroke (n=35) MCA 60.6±6.5** 2.08±0.22*** 0.97±0.20 ACA 50.4±6.9* 1.67±0.16*** 0.88±0.16 PCA 30.8±7.5** 1.45±0.18** 0.83±0.21 Combination of MCA 54.1±8.2** 2.25±0.24*** 1.08±0.25* atherosclerosis and ACA 138±14.5*** 1.75±0.16*** 0.95±0.22 hypertension (n=65) PCA 100±11.5** 2.00±0.15*** 0.90±0.19 Note: reliability of performances to the norm was noted: *- (Р<0.05); **- (Р<0.01); ***- (Р<0.001) When cerebral stroke is accompanied with atherosclerosis and hypertension according to the statistic records such signs as asymmetry of blood flow with hypoperfusion in the affected area are prevailing (p<0.05). In 45.71% cases there were local changing of blood flow with turbulence signs, moderate increase of linear blood flow velocity at ACA (anterior cerebral artery) considerably increasing under the compression of contralateral CCA (common carotid artery), and considerable increase of linear blood flow velocity at PCA (posterior cerebral artery) under the compression of homolateral CCA with lowering of MCA (medium cerebral artery) after the compressive test. In 7.69% of cases there was recorded absence of blood flow at MCA or presence of residual blood flow % patients suffering from the acute blood flow disturbance accompanied with
6 atherosclerosis and hypertension had moderate increase of the linear blood flow velocity with the increase of the peripheral resistance and vascular tone index. Conclusion The results of the undertaken researches demonstrated considerable difference in hemodynamic performances of extracranial vessels of the carotid area in case of the acute cerebral blood flow disturbance of different etiology. Thus, in case of the atherosclerotic lesion the diffusive decrease of blood flow velocity in the carotid brachiocephalic trunks dominates under their stenotic lesion of the diffusive two-sided nature and increase of rigidity and tone of vessels. The diffusive decrease of blood flow velocity against the growth of rigidity of the vessel wall prevails in intracranial vessels. When atherosclerosis was accompanied with hypertension, the acute blood flow disturbance was in line with the early development of stenotic changes with the statistically significant prevailing of the occlusive lesion and signs of the moderate vasomotor spasm. Intracranial perfusion was characterized by the asymmetry of blood flow with hypoperfusion in the affected area. References Barhatov, D., Djubladze, D., Barhatova V., Connection between clinical and biological disturbances under the atherosclerotic lesion of carotid arteries, Journal of Neurology and Psychiatry [Jurnal Nevrologii i Psychiatrii], in Russian, Vol.106(4), pp Belkin, A., Alashev, A., Inyushkin, S., Transcranial dopplerography in intensive therapy. Methodic guideline for the doctors [Transkranialnaya dopplerografiya v intensivnoy terapii. Metodicheskoe rukovodstvo dlya vrachey], in Russian, Ekaterinburg. Gaidar, B., Semenyutin, V., Parfyonov, V., Svistov, D., Transcranial dopplerography in neurosurgery [Transkranialnaya dopplerografiya v nejrohirurgii], in Russian, Saint Petersburg. Goldstein, L., Bertels, C., Davis, J., Interrater reliability of the NIHSS stroke scale, Arch Neurol., Vol.46, pp Gusev, E., Skvortsova, V., Cerebral ischemia [Ishemia golovnogo mozga], in Russian, Moscow: Medicine. Scandinavian Stroke Study Group, Multicenter trial of hemodilution in ischemic stroke - Background and study protocol, Scandinavian Stroke Study Group, Stroke, Vol.16, pp Myasnikov, A., Hypertensive heart disease and atherosclerosis [Gipertonicheskaya bolezn i ateroscleros], in Russian, Moscow: Medicine. Pavlovskaya, N., Ultrastructural changes of capillaries of cerebral cortex in case of ischemia, Neurology and Psychiatry [Jurnal Nevrologii and Psychiatry], in Russian, No.7, pp Pokrovskiy, A., Atherosclerosis of aorta and its branches, in: Chazov, E. (Ed.), Diseases of the heart and blood vessels: A guide for physicians [Bolezni serdsya i sosudov: Rukovodstvo dlya vrachey], in Russian, Moscow: Medicine, Vol.2, pp Shnaider, N., Vinogradova, T., Prophylactic of cerebral arterial thrombosis. Methodical guideline [Profilaktika aterotromboticheskogo insulta. Metodicheskoe posobie], in Russian, Krasnoyarsk: KrasGMA. Skvortsova, V., Ischemic cerebral stroke: pathogenesis of ischemia, therapeutic approaches, Journal of Neurology [Nevrologicheskiy Jurnal], in Russian, No.3, pp.4-9. Skvortsova, V., Sokolov, K., Shamalov, N., Arterial hypertension and cerebral and vascular disturbances, Journal of Neurology and Psychiatry [Jurnal Nevrologii and Psychiatri], in Russian, Vol.106(11), pp Vereschagin, N., Piradov, M., Cerebral infarction: Evaluation of the problem, Journal of Neurology [Nevrologicheskiy Jurnal], in Russian, No.5, pp.4-7. Yahno, N., Shtulman, D., Nervous system diseases [Bolezni nervnoy sistemi], in Russian, Moscow. Yahno, N., Vilenskiy, B., Cerebral infarction in the view of medical and social problem, Russian Medical Journal [Russkiy Medicinskiy Jurnal], in Russian, Vol.13, No.12, pp
TRANSCRANIAL DOPPLER ULTRASOUND INTRODUCTION TO TCD INTERPRETATION
TRANSCRANIAL DOPPLER ULTRASOUND INTRODUCTION TO TCD INTERPRETATION ---Rune Aaslid First TCD Publication 1982 WHAT IS TCD? Uses 2 MHz pulsed Doppler ultrasound Passes through cranial windows Provides information
More informationProtokollanhang zur SPACE-2-Studie Neurology Quality Standards
Protokollanhang zur SPACE-2-Studie Neurology Quality Standards 1. General remarks In contrast to SPACE-1, the neurological center participating in the SPACE-2 trial will also be involved in the treatment
More informationTranscranial Doppler (Basic Step) Dae-il Chang, M.D., Sung Sang Yoon, M.D. Department of Neurology, College of Medicine, Kyunghee university
Transcranial Doppler (Basic Step) Dae-il Chang, M.D., Sung Sang Yoon, M.D. Department of Neurology, College of Medicine, Kyunghee university Principles of Doppler Ultrasonography Major target Speed & direction
More informationNoninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries
J Neurosurg 57:769-774, 1982 Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries RUNE AASLID, PH.D., THOMAS-MARC MARKWALDER, M.D., AND HEt,CE NORNES, M.D.
More information[(PHY-3a) Initials of MD reviewing films] [(PHY-3b) Initials of 2 nd opinion MD]
2015 PHYSICIAN SIGN-OFF (1) STUDY NO (PHY-1) CASE, PER PHYSICIAN REVIEW 1=yes 2=no [strictly meets case definition] (PHY-1a) CASE, IN PHYSICIAN S OPINION 1=yes 2=no (PHY-2) (PHY-3) [based on all available
More informationTranscranial Doppler ultrasonography (TCD)
532 Transcranial Doppler Ultrasound Findings in Middle Cerebral Artery Occlusion M. Kaps, MD, M.S. Damian, MD, U. Teschendorf, and W. Dorndorf, MD We evaluated the efficacy of transcranial Doppler ultrasonography
More informationVivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine
Vivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine Institute The Oregon Clinic Disclosure I declare that neither
More informationEmergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke
Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke Tetsuyoshi Horiuchi, Junpei Nitta, Shigetoshi Ishizaka, Kohei Kanaya, Takao Yanagawa, and Kazuhiro Hongo. Department of Neurosurgery,
More informationDiagnosis of Middle Cerebral Artery Occlusion with Transcranial Color-Coded Real-Time Sonography
Diagnosis of Middle Cerebral Artery Occlusion with Transcranial Color-Coded Real-Time Sonography Kazumi Kimura, Yoichiro Hashimoto, Teruyuki Hirano, Makoto Uchino, and Masayuki Ando PURPOSE: To determine
More informationThe severity of neurologic deficits associated with
Effect of Internal Carotid Artery Occlusion on Intracranial Hemodynamics Transcranial Doppler Evaluation and Clinical Correlation 589 Peter A. Schneider, MD, Mary E. Rossman, RVT, Eugene F. Bernstein,
More informationNeuro Quiz 29 Transcranial Doppler Monitoring
Verghese Cherian, MD, FFARCSI Penn State Hershey Medical Center, Hershey Quiz Team Shobana Rajan, M.D Suneeta Gollapudy, M.D Angele Marie Theard, M.D Neuro Quiz 29 Transcranial Doppler Monitoring This
More informationNoninvasive Methods of Neurovisualization in the Diagnostics of Secondary Ischemia at Nontraumatic Intracranial Hemorrhages
American Journal of Medicine and Medical Sciences 2019, 9(1): 2-4 DOI: 10.592/j.ajmms.20190901.05 Noninvasive Methods of Neurovisualization in the Diagnostics of Secondary Ischemia at Nontraumatic Intracranial
More informationTCD AND VASOSPASM SAH
CURRENT TREATMENT FOR CEREBRAL ANEURYSMS TCD AND VASOSPASM SAH Michigan Sonographers Society 2 Nd Annual Fall Vascular Conference Larry N. Raber RVT-RDMS Clinical Manager General Ultrasound-Neurovascular
More information/ / / / / / Hospital Abstraction: Stroke/TIA. Participant ID: Hospital Code: Multi-Ethnic Study of Atherosclerosis
Multi-Ethnic Study of Atherosclerosis Participant ID: Hospital Code: Hospital Abstraction: Stroke/TIA History and Hospital Record 1. Was the participant hospitalized as an immediate consequence of this
More informationRecommendations for documentation of neurosonographic examinations
Recommendations for documentation of neurosonographic examinations The documentation of ultrasound examinations is subject to a dynamic development particularly as regards newer applications. The present
More informationBlood Supply. Allen Chung, class of 2013
Blood Supply Allen Chung, class of 2013 Objectives Understand the importance of the cerebral circulation. Understand stroke and the types of vascular problems that cause it. Understand ischemic penumbra
More informationHrushchak N.M. The Pharma Innovation Journal 2014; 3(9): 38-42
2014; 3(9): 38-42 ISSN: 2277-7695 TPI 2014; 3(9): 38-42 2013 TPI www.thepharmajournal.com Received: 10-10-2014 Accepted: 23-11-2014 Ivano-Frankivsk national medical university Kalush regional hospital.
More informationUltrasound Imaging of The Posterior Circulation
Ultrasound Imaging of The Posterior Circulation Michigan Sonographers Society 2 Nd Annual Fall Vascular Conference Larry N. Raber RDMS-RVT Clinical Manager General Ultrasound/Neurovascular Laboratory Cleveland
More informationIntracranial Cerebrovascular Evaluation Transcranial Doppler (Non-Imaging) and Transcranial Duplex Imaging (TCD-I)
VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Intracranial Cerebrovascular Evaluation Transcranial Doppler (Non-Imaging) and Transcranial Duplex Imaging (TCD-I) This Guideline was prepared by
More informationReduction of flow velocities in patients with ischemic events in the middle cerebral artery long-term follow-up with ultrasound
Acta Neurol. Belg., 20,, -5 Original articles Reduction of flow velocities in patients with ischemic events in the middle cerebral artery long-term follow-up with ultrasound Christine Kremer and Kasim
More informationOcclusive cerebrovascular disease. A Novel Chronic Cerebral Hypoperfusion Model with Cognitive Impairment and Low Mortality Rate in Rats
FPⅧ-1 A Novel Chronic Cerebral Hypoperfusion Model with Cognitive Impairment and Low Mortality Rate in Rats Ahmed Said Mansour 1, Kuniyasu Niizuma 2, Sherif Rashad 2, Hidenori Endo 2, Toshiki Endo 3, Kenichi
More informationHistory of revascularization
History of revascularization Author (year) Kredel, 1942 Woringer& Kunlin, 1963 Donaghy& Yasargil, 1968 Loughheed 1971 Kikuchini & Karasawa1973 Karasawa, 1977 Story, 1978 Sundt, 1982 EC/IC bypass study
More informationPolicies and Statements D16. Intracranial Cerebrovascular Ultrasound
Policies and Statements D16 Intracranial Cerebrovascular Ultrasound SECTION 1: INSTRUMENTATION Policies and Statements D16 Intracranial Cerebrovascular Ultrasound May 2006 (Reaffirmed July 2007) Essential
More informationCMS Limitations Guide - Radiology Services
CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationHyperperfusion syndrome after MCA embolectomy a rare complication?
ISSN 1507-6164 DOI: 10.12659/AJCR.889672 Received: 2013.08.13 Accepted: 2013.09.11 Published: 2013.11.29 Hyperperfusion syndrome after MCA embolectomy a rare complication? Authors Contribution: Study Design
More informationCarotid Artery Doppler
Carotid Artery Doppler Patient Position supine or semisupine head slightly hyper extended rotated 45 away from the side being examined. Higher frequency linear transducers (7 MHz) Vessels should be imaged
More informationnoninvasive, nonionizing, portable, inexpensive, safe for serial or prolonged studies
TRANS CRANIAL DOPPLER Presented by : Anil Garg Transcranial Doppler 1982, Aaslid and colleagues introduced TCD as a non-invasive technique for monitoring blood flow velocity in basal cerebral arteries
More informationPost-op Carotid Complications A Nursing Perspective of What to Watch Out for
Post-op Carotid Complications A Nursing Perspective of What to Watch Out for By Kariss Peterson, ARNP Swedish Medical Center Inpatient Neurology Team 1 Post-op Carotid Management Objectives Review the
More informationINSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU
CEREBRAL BYPASS An Innovative Treatment for Arteritis INSTITUTE OF NEUROSURGERY & DEPARTMENT OF PICU CASE 1 q 1 year old girl -recurrent seizure, right side limb weakness, excessive cry and irritability.
More informationEnhancement of Cranial US: Utility of Supplementary Acoustic Windows and Doppler Harriet J. Paltiel, MD
Enhancement of Cranial US: Utility of Supplementary Acoustic Windows and Doppler Harriet J. Paltiel, MD Boston Children s Hospital Harvard Medical School None Disclosures Conventional US Anterior fontanelle
More informationGUNDERSEN/LUTHERAN ULTRASOUND DEPARTMENT POLICY AND PROCEDURE MANUAL
GUNDERSEN/LUTHERAN ULTRASOUND DEPARTMENT POLICY AND PROCEDURE MANUAL SUBJECT: Carotid Duplex Ultrasound SECTION: Vascular Ultrasound ORIGINATOR: Deborah L. Richert, BSVT, RDMS, RVT DATE: October 15, 2015
More informationCase Report Cerebral Hyperperfusion Syndrome following Protected Carotid Artery Stenting
Case Reports in Vascular Medicine Volume 2013, Article ID 207602, 4 pages http://dx.doi.org/10.1155/2013/207602 Case Report Cerebral Hyperperfusion Syndrome following Protected Carotid Artery Stenting
More informationPosterior Cerebral Artery Aneurysms with Common Carotid Artery Occlusion: A Report of Two Cases
Journal of Neuroendovascular Therapy 2017; 11: 371 375 Online March 3, 2017 DOI: 10.5797/jnet.cr.2016-0114 Posterior Cerebral Artery Aneurysms with Common Carotid Artery Occlusion: A Report of Two Cases
More informationManagement of intracranial atherosclerotic stenosis (ICAS)/intracranial atherosclerosis
Management of intracranial atherosclerotic stenosis (ICAS)/intracranial atherosclerosis Tim Mikesell, D.O. Oct 22, 2016 Stroke facts Despite progress in decreasing stroke incidence and mortality, stroke
More informationMusical murmurs (MMs), also called seagull cry, goose
ORIGINAL RESEARCH S.-K. Lin S.-J. Ryu Y.-J. Chang T.-H. Lee Clinical Relevance of Musical Murmurs in Color-Coded Carotid and Transcranial Duplex Sonographies BACKGROUND AND PURPOSE: Musical murmurs (MMs),
More informationAcute Complications of Sickle Cell Disease Case Study 5 year old girl with Hemoglobin SS, weakness and slurred speech
Acute Complications of Sickle Cell Disease Case Study 5 year old girl with Hemoglobin SS, weakness and slurred speech Beatrice E. Gee, MD Medical Director, Sickle Cell and Hematology Program Children s
More informationCerebral hyperperfusion syndrome after carotid angioplasty
case report Cerebral hyperperfusion syndrome after carotid angioplasty Zoran Miloševič 1, Bojana Žvan 2, Marjan Zaletel 2, Miloš Šurlan 1 1 Institute of Radiology, 2 University Neurology Clinic, University
More informationClinical Study Relationship between Pulsatility Index and Clinical Course of Acute Ischemic Stroke after Thrombolytic Treatment
BioMed Research International Volume 213, Article ID 265171, 5 pages http://dx.doi.org/1.1155/213/265171 Clinical Study Relationship between Pulsatility Index and Clinical Course of Acute Ischemic Stroke
More informationCarotid Embolectomy and Endarterectomy for Symptomatic Complete Occlusion of the Carotid Artery as a Rescue Therapy in Acute Ischemic Stroke
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the article
More informationStroke School for Internists Part 1
Stroke School for Internists Part 1 November 4, 2017 Dr. Albert Jin Dr. Gurpreet Jaswal Disclosures I receive a stipend for my role as Medical Director of the Stroke Network of SEO I have no commercial
More informationNEURORADIOLOGY DIL part 4
NEURORADIOLOGY DIL part 4 Strokes and infarcts K. Agyem MD, G. Hall MD, D. Palathinkal MD, Alexandre Menard March/April 2015 OVERVIEW Introduction to Neuroimaging - DIL part 1 Basic Brain Anatomy - DIL
More informationPractical Considerations in the Early Treatment of Acute Stroke
Practical Considerations in the Early Treatment of Acute Stroke Matthew E. Fink, MD Neurologist-in-Chief Weill Cornell Medical College New York-Presbyterian Hospital mfink@med.cornell.edu Disclosures Consultant
More informationNicolas Bianchi M.D. May 15th, 2012
Nicolas Bianchi M.D. May 15th, 2012 New concepts in TIA Differential Diagnosis Stroke Syndromes To learn the new definitions and concepts on TIA as a condition of high risk for stroke. To recognize the
More information(Department of Radiology, Beylikdüzü State Hospital, İstanbul, Turkey) Corresponding Author: Dr. Mete Özdikici
Quest Journals Journal of Medical and Dental Science Research Volume 5~ Issue 6 (2018) pp: 61-65 ISSN(Online) : 2394-076X ISSN (Print):2394-0751 www.questjournals.org Research Paper Quantitative Measurements
More informationEvaluation of Carotid Vessels and Vertebral Artery in Stroke Patients with Color Doppler Ultrasound and MR Angiography
Evaluation of Carotid Vessels and Vertebral Artery in Stroke Patients with Color Doppler Ultrasound and MR Angiography Dr. Pramod Shaha 1, Dr. Vinay Raj R 2, Dr. (Brig) K. Sahoo 3 Abstract: Aim & Objectives:
More informationAsymptomatic Occlusion of an Internal Carotid Artery in a Hospital Population: Determined by Directional Doppler Ophthalmosonometry
Asymptomatic Occlusion of an Internal Carotid Artery in a Hospital Population: Determined by Directional Doppler Ophthalmosonometry BY MARK L. DYKEN, M.D.,* J. FREDERICK DOEPKER, JR., RICHARD KIOVSKY,
More informationCerebral Vascular Diseases. Nabila Hamdi MD, PhD
Cerebral Vascular Diseases Nabila Hamdi MD, PhD Outline I. Stroke statistics II. Cerebral circulation III. Clinical symptoms of stroke IV. Pathogenesis of cerebral infarcts (Stroke) 1. Ischemic - Thrombotic
More informationThe NIHSS score is 4 (considering 2 pts for the ataxia involving upper and lower limbs.
Neuroscience case 5 1. Speech comprehension, ability to speak, and word use were normal in Mr. Washburn, indicating that aphasia (cortical language problem) was not involved. However, he did have a problem
More informationTIA AND STROKE. Topics/Order of the day 1. Topics/Order of the day 2 01/08/2012
Charles Ashton Medical Director TIA AND STROKE Topics/Order of the day 1 What Works? Clinical features of TIA inc the difference between Carotid and Vertebral territories When is a TIA not a TIA TIA management
More informationTranscranial dopplerography in acute left-hemispheric ischemic stroke.
Research Article http://www.alliedacademies.org/journal-brain-neurology/ Transcranial dopplerography in acute left-hemispheric ischemic stroke. Abdullaiev RYA 1*, Sysun LA 1, Tovazhnyanska OL 2, Posokhov
More informationCarotid Abnormalities Coils, Kinks and Tortuosity David Lorelli M.D., RVT, FACS Michigan Vascular Association Conference Saturday, October 20, 2012
Carotid Abnormalities Coils, Kinks and Tortuosity David Lorelli M.D., RVT, FACS Michigan Vascular Association Conference Saturday, October 20, 2012 Page 1 Table of Contents Carotid Anatomy Carotid Duplex
More informationStudy of capabilities of making detection device for cerebral ischemic state
Medical Research and Innovations Review Article ISSN: 2514-3700 Study of capabilities of making detection device for cerebral ischemic state Lobekin VN, Petrov RV, Bichurin MI*, Rebinok AV and Sulimanov
More informationExtra- and intracranial tandem occlusions in the anterior circulation - clinical outcome of endovascular treatment in acute major stroke.
Extra- and intracranial tandem occlusions in the anterior circulation - clinical outcome of endovascular treatment in acute major stroke. Poster No.: C-1669 Congress: ECR 2014 Type: Scientific Exhibit
More informationANASTAMOSIS FOR BRAIN STEM ISCHEMIA/Khodadad et al.
ANASTAMOSIS FOR BRAIN STEM ISCHEMIA/Khodadad et al. visualization of the posterior inferior cerebellar artery. The patient, now 11 months post-operative, has shown further neurological improvement since
More informationImaging of the Basal Cerebral Arteries and Measurement of Blood Velocity in Adults by Using Transcranial Real-Time Color Flow Doppler Sonography
497 Imaging of the Basal Cerebral Arteries and Measurement of Blood Velocity in Adults by Using Transcranial Real-Time Color Flow Doppler Sonography Takashi Tsuchiya 1 Masahiro Yasaka Takenori Yamaguchi
More informationPTA 106 Unit 1 Lecture 3
PTA 106 Unit 1 Lecture 3 The Basics Arteries: Carry blood away from the heart toward tissues. They typically have thicker vessels walls to handle increased pressure. Contain internal and external elastic
More informationEFFICACY AND SAFETY OF INTRA-ARTERIAL THROMBOLYTIC
Open Access Research Journal Medical and Health Science Journal, MHSJ www.pradec.eu ISSN: 1804-1884 (Print) 1805-5014 (Online) Volume 10, 2012, pp. 2-9 EFFICACY AND SAFETY OF INTRA-ARTERIAL THROMBOLYTIC
More informationAssessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound
J Neurosurg 63:890-898,1985 Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound KARL-FREDRIK LINDEGAARD, M.D., S~REN JACOB BAKKE, M.D., PETER GROLIMUND,
More informationMoyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature
Romanian Neurosurgery Volume XXXI Number 3 2017 July-September Article Moyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature Ashish Kumar Dwivedi, Pradeep Kumar,
More informationOcclusion of All Four Extracranial Vessels With Minimal Clinical Symptomatology. Case Report
Occlusion of All Four Extracranial Vessels With Minimal Clinical Symptomatology. Case Report BY JIRI J. VITEK, M.D., JAMES H. HALSEY, JR., M.D., AND HOLT A. McDOWELL, M.D. Abstract: Occlusion of All Four
More informationAntegrade and retrograde flow of carotid
Antegrade and retrograde flow of carotid The ECA waveform is high resistance and may have retrograde flow in diastole.. They should always demonstrate antegrade flow (toward the brain) and be. external
More informationBrain Attack. Strategies in the Management of Acute Ischemic Stroke: Neuroscience Clerkship. Case Medical Center
Brain Attack Strategies in the Management of Acute Ischemic Stroke: Neuroscience Clerkship Stroke is a common and devastating disorder Third leading antecedent of death in American men, and second among
More informationOcclusio Supra Occlusionem: Intracranial Occlusions Following Carotid Thrombosis as Diagnosed by Cerebral Angiography
Occlusio Supra Occlusionem: Intracranial Occlusions Following Carotid Thrombosis as Diagnosed by Cerebral Angiography BY B. ALBERT RING, M.D. Abstract: Occlusio Supra Occlusionem: Intracranial Occlusions
More informationTranscranial Doppler In Cerebral Vasospasm
Cerebral Vasospasm 1042-3680/90 $0.00 +.20 Transcranial Doppler In Cerebral Vasospasm David W. Newell, MD,* and H. Richard Winn, MDt The confirmation of cerebral vasospasm following subarachnoid hemorrhage,
More informationNON-ATHEROSCLEROTIC PATHOLOGY OF THE CAROTID ARTERIES
NON-ATHEROSCLEROTIC PATHOLOGY OF THE CAROTID ARTERIES Leslie M. Scoutt, MD, FACR Professor of Diagnostic Radiology & Surgery Vice Chair, Dept of Radiology & Biomedical Imaging Chief, Ultrasound Section
More informationTCD and cardiac arrest
TCD and cardiac arrest Background: An effective tissue perfusion has decisive influence on the final prognosis both during cardiopulmonary resuscitation (CPR) and after recovery of spontaneous circulation
More informationUvA-DARE (Digital Academic Repository) Cerebral autoregulation: from minutes to seconds Immink, R.V. Link to publication
UvA-DARE (Digital Academic Repository) Cerebral autoregulation: from minutes to seconds Immink, R.V. Link to publication Citation for published version (APA): Immink, R. V. (2013). Cerebral autoregulation:
More informationA Base of Observations and a Base of Knowledge for «Carotid constriction» Disease Formed by the Ontology for Medical Diagnostics
A Base of Observations and a Base of Knowledge for «Carotid constriction» Disease Formed by the Ontology for Medical Diagnostics Mery Yu. Chernyakhovskaya, and Philip M. Moskalenko Abstract--The paper
More informationIn cerebral infarction, the prognostic value of angiographic
Nonrelevant Cerebral Atherosclerosis is a Strong Prognostic Factor in Acute Cerebral Infarction Jinkwon Kim, MD; Tae-Jin Song, MD; Dongbeom Song, MD; Hye Sun Lee, MS; Chung Mo Nam, PhD; Hyo Suk Nam, MD,
More informationCT and MR Imaging in Young Stroke Patients
CT and MR Imaging in Young Stroke Patients Ashfaq A. Razzaq,Behram A. Khan,Shahid Baig ( Department of Neurology, Aga Khan University Hospital, Karachi. ) Abstract Pages with reference to book, From 66
More informationDisclosure Statement:
Marsha M. Neumyer, BS, RVT, FSVU, FSDMS, FAIUM International Director Vascular Diagnostic Educational Services Vascular Resource Associates Harrisburg, PA Disclosure Statement: CME Calendar QR Code Marsha
More informationLearning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship
Learning Objectives for Rotations in Vascular Surgery Year 3 Basic Clerkship CLINICAL PROBLEMS IN VASCULAR SURGERY 1. ABDOMINAL AORTIC ANEURYSM A 70 year old man presents in the emergency department with
More informationCarotid Endarterectomy for Symptomatic Complete Occlusion of the Internal Carotid Artery
2011 65 4 239 245 Carotid Endarterectomy for Symptomatic Complete Occlusion of the Internal Carotid Artery a* a b a a a b 240 65 4 2011 241 9 1 60 10 2 62 17 3 67 2 4 64 7 5 69 5 6 71 1 7 55 13 8 73 1
More informationComparison of Five Major Recent Endovascular Treatment Trials
Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline
More informationAnatomy and Physiology, Spring 2015 Exam II: Form A April 9, Name Student Number
Anatomy and Physiology, Spring 2015 Exam II: Form A April 9, 2015 Name Student Number For Questions 1 2 refer to the following table. 1 Ventricular pressure is greater than aortic 6 AV valve is open 2
More informationStroke - Intracranial hemorrhage. Dr. Amitesh Aggarwal Associate Professor Department of Medicine
Stroke - Intracranial hemorrhage Dr. Amitesh Aggarwal Associate Professor Department of Medicine Etiology and pathogenesis ICH accounts for ~10% of all strokes 30 day mortality - 35 45% Incidence rates
More informationAlthough moyamoya disease, a rare cerebrovascular occlusive
Renal Artery Lesions in Patients With Moyamoya Disease Angiographic Findings Ichiro Yamada, MD; Yoshiro Himeno, MD; Yoshiharu Matsushima, MD; Hitoshi Shibuya, MD Background and Purpose Renal artery lesions
More informationWhat effects will proximal or distal disease have on an waveform?
Spectral Doppler Interpretation Director Director of of Ultrasound Ultrasound Education Education & & Quality Quality Assurance Assurance Baylor Baylor College College of of Medicine Medicine Division
More informationUPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015
UPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015 NEW STUDIES FOR 2015 MR CLEAN ESCAPE EXTEND-IA REVASCAT SWIFT PRIME RECOGNIZED LIMITATIONS IV Alteplase proven benefit
More informationPhysiology lecture 15 Hemodynamic
Physiology lecture 15 Hemodynamic Dispensability (D) : proportional change in volume per unit change in pressure D = V/ P*V It is proportional (divided by the original volume). Compliance (C) : total change
More informationEssentials of Clinical MR, 2 nd edition. 14. Ischemia and Infarction II
14. Ischemia and Infarction II Lacunar infarcts are small deep parenchymal lesions involving the basal ganglia, internal capsule, thalamus, and brainstem. The vascular supply of these areas includes the
More informationRenal Doppler Diagnostics in Lead-, Nickel- and Manganese-Exposed Children
666 Renal Doppler Diagnostics in Lead-, Nickel- and Manganese-Exposed Children Nina Zaitseva 1, Olga Ustinova 2, Olga Vozgoment 3, Alfiya Aminova 4 *, Alevtina Akatova 5, Yuliya Perlova 6, Irina Shtina
More informationManagement of cervicocephalic arterial dissection. Ciro G. Randazzo, MD, MPH Thomas Jefferson University Hospital, Department of Neurosurgery
Management of cervicocephalic arterial dissection Ciro G. Randazzo, MD, MPH Thomas Jefferson University Hospital, Department of Neurosurgery Definition Disruption of arterial wall, either at level of intima-media
More informationSTRUCTURED EDUCATION REQUIREMENTS IMPLEMENTATION DATE: JULY 1, 2016
STRUCTURED EDUCATION REQUIREMENTS Vascular Sonography The purpose of structured education is to provide the opportunity for individuals to develop mastery of discipline-specific knowledge that, when coupled
More informationCLINICAL FEATURES THAT SUPPORT ATHEROSCLEROTIC STROKE 1. cerebral cortical impairment (aphasia, neglect, restricted motor involvement, etc.) or brain stem or cerebellar dysfunction 2. lacunar clinical
More informationDisclosures. CREST Trial: Summary. Lecture Outline 4/16/2015. Cervical Atherosclerotic Disease
Disclosures Your Patient Has Carotid Bulb Stenosis and a Tandem Intracranial Stenosis: How Do SAMMPRIS and Other Evidence Inform Your Treatment? UCSF Vascular Symposium 2015 Steven W. Hetts, MD Associate
More informationModule 4. Ischemia in Carotid Territory
Module 4. Ischemia in Carotid Territory Introduction and Key Clinical Examples Objectives for Module 4 Knowledge! Describe two common TIAs (mini-strokes) that are seen with ischemia in carotid territory.!
More informationCorrelation of Common Carotid Artery Intima Media Thickness, Intracranial Arterial Stenosis and Post-stroke Cognitive Impairment
207 Correlation of Common Carotid Artery Intima Media Thickness, Intracranial Arterial Stenosis and Post-stroke Cognitive Impairment Yong-Hui Lee and Shoou-Jeng Yeh Abstract- Background and Purpose: Atherosclerosis
More informationtechniques in the diagnosis of carotid artery diseases
Journal ofneurology, Neurosurgery, and Psychiatry, 1979, 42, 563-568 Assessment of directional doppler ultrasound techniques in the diagnosis of carotid artery diseases D. R. PRICHARD., T. R. P. MARTIN,
More informationThe Oxfordshire Community Stroke Project (OCSP) devised
Relationship Between Pattern of Intracranial Artery Abnormalities on Transcranial Doppler and Oxfordshire Community Stroke Project Clinical Classification of Ischemic Stroke G.E. Mead, MD; J.M. Wardlaw,
More informationTCD IN THE NICU, PICU AND OTHER APPLICATIONS. Dorothy Bulas M.D. Professor of Pediatrics & Radiology Children s National Washington D.C.
TCD IN THE NICU, PICU AND OTHER APPLICATIONS Dorothy Bulas M.D. Professor of Pediatrics & Radiology Children s National Washington D.C. Objectives Recognize normal and abnormal cranial blood flow patterns
More informationPrinciples Arteries & Veins of the CNS LO14
Principles Arteries & Veins of the CNS LO14 14. Identify (on cadaver specimens, models and diagrams) and name the principal arteries and veins of the CNS: Why is it important to understand blood supply
More informationImage Formation (10) 2 Evaluation and Selection of Representative Images (10)
STRUCTURED SELF ASSESSMENT CONTENT SPECIFICATIONS SSA LAUNCH DATE: JANUARY 1, 2018 Vascular Sonography The purpose of continuing qualifications requirements (CQR) is to assist registered technologists
More informationVascular Sonography Examination
Vascular Sonography Examination The purpose of The American Registry of Radiologic Technologists (ARRT ) Vascular Sonography Examination is to assess the knowledge and cognitive skills underlying the intelligent
More informationTranscranial Color-Coded Duplex Sonography in Unilateral Flow-Restrictive Extracranial Carotid Artery Disease
Transcranial Color-Coded Duplex Sonography in Unilateral Flow-Restrictive Extracranial Carotid Artery Disease Ralf W. Baumgartner, Iris Baumgartner, Heinrich P. Mattle, and Gerhard Schroth PURPOSE: To
More informationRedgrave JN, Coutts SB, Schulz UG et al. Systematic review of associations between the presence of acute ischemic lesions on
6. Imaging in TIA 6.1 What type of brain imaging should be used in suspected TIA? 6.2 Which patients with suspected TIA should be referred for urgent brain imaging? Evidence Tables IMAG1: After TIA/minor
More informationTO CATCH A THIEF: IMAGING OF SUBCLAVIAN STEAL
October 2013 TO CATCH A THIEF: IMAGING OF SUBCLAVIAN STEAL Sumir Pandit, Harvard Medical School, Year III 1 AGENDA Introduction to our patient A.B. Anatomy review of aorta and branches CT imaging of our
More informationHow to Think like a Neurologist Review of Exam Process and Assessment Findings
Lehigh Valley Health Network LVHN Scholarly Works Neurology Update for the Non-Neurologist 2013 Neurology Update for the Non-Neurologist Feb 20th, 5:10 PM - 5:40 PM How to Think like a Neurologist Review
More informationCarotid Imaging IT S ABOUT MORE THAN JUST OBTAINING THE IMAGES
Carotid Imaging IT S ABOUT MORE THAN JUST OBTAINING THE IMAGES No financial or commercial relationships to disclose Carotid artery disease: Stroke is one of the most serious causes of mortality and morbidity
More information