Abstract
Internal carotid artery dissection (ICD) causes transient ischemic attack (TIA) or stroke by hemodynamic or thromboembolic mechanisms. Diagnosis of ICD is made by angiography. The aim of this study was to evaluate the role of three-dimensional transcranial Doppler (TCD-3D) in ICD.
The authors report a fifty-seven-year-old man presenting sudden aphasia, left neck pain, and homolateral headache and a sixty-year-old man presenting sudden right neck pain, homolateral headache, and Horner's syndrome. Selective digital subtraction angiography showed the typical elongated regular stenosis (string sign) of ICD. At onset TCD-3D revealed in both patients: (1) decreased blood flow velocity over the internal carotid dissected segment and inverted flow velocity over the homolateral anterior cerebral and ophthalmic artery; (2) reduced pulsatility index with normal blood flow velocity over the homolateral middle cerebral artery suggestive of valid autoregulation of cerebral blood flow (CBF). TCD-3D at days 15 and 40 and at months 2 and 6 after stroke showed progressive recanalization beginning from the day 40 in the first patient and from the day 15 in the second patient with successive complete normalization of Doppler parameters.
Although angiography remains the most reliable diagnostic study, TCD-3D results are useful for evaluating, in the acute phase, the efficacy of collateral blood supply and autoregulation of CBF, which are important as prognostic indexes and as indications for therapeutic strategy, and, afterward, for the timing of recanalization indicative of a good long-term prognosis.
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