Noninvasive Cerebrovascular Diagnosis
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Another hypothesis suggests the role of insufficient acetylcholine production necessary for vasodilatation. Therapeutic tests with acetylcholine inhibitors galantamine or donepezil demonstrated an increase in flow velocities and improvement of vessel reactivity in both VD and AD Rosengarten et al. MCI patients with pathological values of BHI have greater risk of converting to dementia than patients with normal values Viticchi et al. Details of ultrasound projects focused on flow velocities and cerebrovascular reserve capacity in AD are listed in Table 3.
Table 3. Flow velocities, cerebrovascular resistance, and cerebrovascular reserve capacity. Recent evidence suggests that cerebral microemboli can lead to a cognitive decline Pugsley et al. Cerebral microemboli can originate from arterial sources or venous sources in setting of right—left shunts intracardiac — foramen ovale patens, atrial septal defects. The spontaneous cerebral embolization can be monitored using a headframe with attached ultrasound probes for time periods of usually 1—24 h.
Right—left shunts are examined by intravenous injection of a microbubble agent agitated saline or hydroxyethyl starch and observing the presence of microbubbles in brain vessels using transcranial ultrasound at rest and during the Valsalva maneuver. The sensitivity and reproducibility of the examination is highest when performed repeatedly twice with the use of Valsalva maneuver Droste et al. There were not many studies focused on spontaneous cerebral embolization in AD.
One work suggested that it is more frequent in patients with AD or VD than in healthy controls Purandare et al. This suggestion was later confirmed by a larger case—control study Purandare et al. In this particular project, there was no significant difference in the incidence of carotid artery atherosclerosis — i.
The same author found the association of spontaneous cerebral microembolization with more rapid cognitive decline in dementia Purandare and Burns, Details of ultrasound projects focused on spontaneous and paradoxical embolization in AD are listed in Table 4. Table 4. Spontaneous cerebral microembolization and paradoxical embolization via right—left shunts.
The current evidence suggests that the brain perfusion in AD patients, in general, is impaired compared to healthy non-demented population.
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The most prominent ultrasonographical findings in extracranial circulation in AD patients show an increased IMT and higher burden of carotid artery atherosclerosis. The most often identified changes in intracranial circulation are lower flow velocities, lower total CBF not explained by brain atrophy only , and most notably impaired cerebrovascular reserve capacity Table 5.
These findings seem to be valid for both AD and VD. Ultrasonography of extra- and intracranial brain vessels can be helpful in AD patients to identify individuals who are in a higher risk of disease progression. Ultrasonography can be also useful for stratification of MCI patients and can contribute to predict the risk of conversion to AD.
Cerebrovascular Disease Statistics
The vascular risk factors surveillance and treatment in preclinical stages of AD is of great clinical importance and it could help to delay the development of cognitive decline in susceptible individuals. Ultrasonography is not especially beneficial in differentiating AD and VD, because the microvasculature is altered in both types of dementia. All the authors took part in detailed study and interpretation of the reviewed articles. All the authors took part in writing various sections of this article.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Albayrak, R. Evaluation of total cerebral blood flow volume in cerebral atrophy. Asil, T. Differentiation of vascular dementia and Alzheimer disease: a functional transcranial Doppler ultrasonographic study.
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Cervical (Carotid or Vertebral) Artery Dissection
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Stroke 25, — Job, F. Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients. Advertisement Hide. Noninvasive Cerebrovascular Diagnosis. Front Matter Pages I-V. Overview of Cerebrovascular Disease.
Cerebral Angiography (Brain Angiogram)
Pages Overview of Various Noninvasive Cerebrovascular Techniques. Duplex Scanning of the Carotid Arteries. Clifford T. Araki, Bruce L. Mintz, Robert W. Hobson II. Vertebral Artery Ultrasonography. Such tests can yield valuable physiologic data in patients with TIAs and can identify patients with soft signs who may have significant carotid artery disease and who may be candidates for angiography.
It may be an effective means of reducing the number of negative carotid angiograms. View PDF.
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Save to Library. Create Alert. Share This Paper. Tables and Topics from this paper. Citations Publications citing this paper. Digital subtraction angiography in patients with cerebral ischaemic attacks and normal continuous wave Doppler studies. Guidotti , Gianluca Landi , G. Scotti , G. References Publications referenced by this paper. MP Spencer. Experience with a noninvasive evaluation for cerebral vascular disease.