Literature Review of articles inTranscranial DopplerTCDDopplerUltrasonographyVasospasmAngiographyExamination
[New indications for transcranial Doppler--huge steps forward]
Huge steps forward in understanding and treatment of ischemic stroke happened in the last several decades. Significant part of this progress is due to advances in diagnostic possibilities, with the leading role of transcranial Doppler (TCD). The American Academy of Neurology has recently published new guidelines and indications for TCD use. Indications with the highest rank, when TCD is able to provide information with established clinical utility, are designated as follows: (1) screening of children aged 2 to 16 years with sickle cell disease for assessing the stroke risk, and (2) detection and monitoring of vasospasm in spontaneous subarachnoid hemorrhage. TCD indications in setting where this examination provides important information but with still indefinite clinical utility are: (1) intracranial steno-occlusive disease, with data insufficient to recommend replacement of conventional angiography with TCD, despite obvious TCD usefulness and precision, and (2) cerebral circulatory arrest detection, as confirmatory test in support of clinical diagnosis of brain death. The major limiting factor of TCD application is dependence on an examiner's training and skills. Only strict application of diagnostic protocols and accepted criteria, with knowledge of pathophysiologic basis of cerebrovascular diseases and TCD principles, can result in conclusive findings. TCD is the source of valuable information for neurologists and other specialty physicians. This text presents review of other TCD indications and their application in everyday practice.