• Alejandro M Brunser, Pablo M Lavados, Daniel A Cárcamo, Arnold Hoppe, Verónica Olavarría, Violeta Diaz, and Rodrigo Rivas.
• Cerebrovascular Program, Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Santiago, Chile. abrunser@alemana.cl
• Cerebrovasc. Dis. 2010 Aug 1; 30 (3): 260-6.

BackgroundTranscranial Doppler (TCD) ultrasound can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with cerebral infarction.MethodsPatients admitted between April 2006 and June 2007 with ischemic stroke of less than 24 h were subjected to a protocol consisting of non-contrast brain CT, computed tomography angiography, diffusion-weighted magnetic resonance imaging and then TCD within the following 6 h by an observer blinded to the results of imaging studies.ResultsSeventy-nine patients were included. The imaging protocol was performed 457 (+/-346) min after stroke symptoms and TCD after 572 (+/-376) min. TCD provided additional information in 28 cases (35.4%, 95% CI 25.7-46.4). More that one piece of additional information was obtained in 6 patients. The most frequent additional information was collateral pathways. Multivariate analysis demonstrated that intracranial vessel occlusion was the variable most associated with additional information. In 7 patients (8.8%, 95% CI 4.3-17.1), additional information changed management: in 4 an additional angiography was performed, in 2 patients angiography was suspended and in 1 aggressive neurocritical care was indicated. Patients with NIHSS >10 were significantly more likely to have their initial treatment changed (p = 0.004).ConclusionsTCD can provide additional information to a multimodal acute ischemic stroke imaging protocol in a third of patients. This can result in changes in the management in some of these patients.Copyright 2010 S. Karger AG, Basel.

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