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.
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[Show abstract][Hide abstract]ABSTRACT: Vascular dementia (VaD) is the second most frequent dementia after Alzheimer's disease, and is diagnosed during lifetime in 20% of demented patients. Five-year survival rate in VaD is 39%, while it is estimated to be 75% in healthy persons of the same age. It is therefore important to make correct diagnosis of VaD early in the course of the disease. Risk factors forVaD are identical to stroke risk factors, and there are significant possibilities for the prevention of vascular cognitive decline. Cognitive decline develops acutely or step-by-step within three months after stroke, but more gradual progression of intellectual decline is also possible. Neurological examination can reveal pyramidal and extrapyramidal signs, pseudobulbar palsy, gait disturbance and urinary incontinence. Neuropsychological profile comprises the loss of cognitive set shifting, decline in word fluency, verbal learning difficulties, perseverations, difficulties in complex figure copying, and in patients with cortically located lesions also problems with speech and praxia. The basis of the diagnosis is, besides history, neurological examination and neuropsychological assessment, computed tomography and/ or magnetic resonance brain imaging. Vascular risk factors control is the most important measure in VaD prevention. Modern guidelines for the treatment of cognitive decline in VaD emphasize that donepezil can be useful in the improvement of cognitive status at the level of Class Ila recommendation at the level of evidence A, while memantine may be useful in patients with mixed VaD and Alzheimer's disease dementia.
Preview · Article · Mar 2013 · Srpski arhiv za celokupno lekarstvo