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Joanna M. Wardlaw, G. T. Vaughan, A. James W. Steers and Robin J. Sellar

to be sufficiently diagnostic in this case. Fig. 1. Transcranial Doppler ultrasound recordings through the temporal bone window of the left (A and B) and right (C and D) middle cerebral arteries (MCA's) at a depth of 45 mm (A and C) or 55 mm (B and D) from the skin surface showing the prominent venous signals immediately adjacent to the MCA signals. The annotations shown in A also apply to B, C, and D. The typical MCA pulsatile arterial signal (thin arrow) is seen above the baseline (arrowhead) , indicating flow toward the probe and away from the center

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Cole A. Giller, Dana Mathews, Brandy Walker, Philip Purdy and Angie M. Roseland

examination or measurement of cerebral blood flow. 12 Both methods require interventional angiography and transport of the patient to an examination suite, and neither can be performed frequently. However, an indication of the adequacy of perfusion during carotid artery occlusion can be obtained at the bedside noninvasively by insonating the middle cerebral artery (MCA) by means of transcranial Doppler ultrasound (TCD) studies during brief manual compression of the ipsilateral carotid artery. 6 The purpose of this report is to compare this quick bedside test with the

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E. Clarke Haley Jr., Neal F. Kassell, James C. Torner and Participants

double-blind place-bo-controlled analysis of the effects of high-dose intravenous nicardipine in patients with aneurysmal SAH. 8 While the overall study focused on clinical outcome as the primary endpoint, the participants in the trial were required to send all cerebral angiographic studies performed for clinical purposes at baseline and between Days 7 and 11 following hemorrhage to the Central Registry of the Cooperative Aneurysm Study for blinded review and interpretation. * Additionally, in those centers with access to transcranial Doppler ultrasound (TCD), serial

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Neil A. Martin, Curtis Doberstein, Cynthia Zane, Michael J. Caron, Kathleen Thomas and Donald P. Becker

not yet been developed for vasospasm, and it was regarded only as a potentially important pathophysiological factor rather than a focal point of diagnostic or therapeutic efforts. With the advent of computerized tomography (CT), angiography has been performed much less frequently in the evaluation of patients with head injury, and vasospasm as a complication of trauma has been neglected. The recent development of transcranial Doppler ultrasound (TCD) monitoring has made it possible to diagnose intracranial arterial spasm noninvasively. This test is ideally suited

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Lee H. Monsein, Alex Y. Razumovsky, Stacey J. Ackerman, Haring J. W. Nauta and Daniel F. Hanley

T he Doppler theory was first formulated in 1842 by the Austrian physicist Christian Doppler and was verified by the Dutch physicist Buys Ballot 3 years later. 1 The application of the Doppler principle to the noninvasive study of the intracranial circulation was suggested by Kaneko 9 as early as 1960. It was not until 1981, however, that the first transcranial Doppler (TCD) ultrasound examination was performed by Aaslid, et al. 3 Since that time, TCD has been used to study a variety of cerebrovascular diseases. Transcranial Doppler ultrasound is

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Joanna M. Wardlaw, Ruth Offin, Graham M. Teasdale and Evelyn M. Teasdale

ultrasound. J Neurosurg 66 : 718 – 728 , 1987 Harders AG, Gilsbach JM: Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound. J Neurosurg 66: 718–728, 1987 9. Hijdra A , Brouwers PJ , Vermeulen M , et al : Grading the amount of blood on computed tomograms after subarachnoid haemorrhage. Stroke 21 : 1156 – 1161 , 1990 Hijdra A, Brouwers PJ, Vermeulen M, et al: Grading the amount of blood on computed tomograms after subarachnoid

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Antônio A F. De Salles and Iñaki Manchola

-beam therapy. Patients with poorly controlled seizures were excluded. Neurological and neuro-ophthalmological examinations, electrocardiograms, computerized tomography scans, cerebral angiograms, and TCD studies were obtained for all patients. The diagnosis for two patients with angiographic occult vascular abnormality was made using magnetic resonance imaging. Fourteen healthy volunteers served as control subjects. There were nine men and five women with a mean age of 30 years (range 21 to 42 years). Angiographic and Transcranial Doppler Ultrasound Studies Bilateral

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Rune Aaslid, Thomas-Marc Markwalder and Helge Nornes

in the middle, anterior, and posterior cerebral arteries (MCA, ACA, and PCA) using a noninvasive transcranial Doppler ultrasound technique. Clinical Material and Methods Fifty healthy subjects with no history of cerebral vascular disease were investigated. Their ages ranged from 20 to 65 years, with a mean of 36 years. For the present study we used a laboratory prototype range-gated Doppler instrument with the following characteristics. Emitted ultrasonic frequency 2 mHz; burst repetition rate 6.8 to 18 kHz; burst length 10 µsec; high pass filter 100 Hz

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Domenico G. Iacopino, Alfredo Conti, Calogero Battaglia, Clotilde Siliotti, Tullio Lucanto, Letterio B. Santamaria and Francesco Tomasello

, et al : Cerebral autoregulation in humans. Stroke 20 : 45 – 52 , 1989 Aaslid R, Lindegaard KF, Sorteberg W, et al: Cerebral autoregulation in humans. Stroke 20: 45–52, 1989 2. Aaslid R , Markwalder TM , Nornes H : Noninvasive transcranial doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57 : 769 – 774 , 1982 Aaslid R, Markwalder TM, Nornes H: Noninvasive transcranial doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57

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Karl-Fredrik Lindegaard, Peter Grolimund, Rune Aaslid and Helge Nornes

have considerable clinical value. Transcranial Doppler ultrasound permits noninvasive recording of blood flow velocities in basal cerebral arteries. 2, 11 In a series of healthy volunteers, we have previously demonstrated that there is relatively little variation with regard to the time-mean value and the pulsatility of the velocity spectrum outlines that are recorded from different basal cerebral arteries in the same individual. 11 This indicates that identical hemodynamic conditions prevail in different areas of the normal brain. In an AVM, the resistance is