Ultraschall Med 2012; 33(3): 218-235
DOI: 10.1055/s-0031-1299455
Fort- und Weiterbildung/Continuing Education
© Georg Thieme Verlag KG Stuttgart · New York

Neurosonografie in der neurologischen Notfall- und Intensivmedizin: Grundlagen, vaskuläre Schlaganfalldiagnostik und Monitoring – Teil 1

J. U. Harrer
1   Klinik für Neurologie, Caritas Klinik St. Theresie, Saarbrücken und Klinik für Neurologie, Universitätsklinikum Aachen, RWTH Aachen
,
J. Eyding
2   Klinik für Neurologie, Knappschaftskrankenhaus, Ruhr-University Bochum
,
M. Ritter
3   Klinik für Neurologie, Universität Münster
,
U. Schminke
4   Klinik für Neurologie, Universitätsmedizin Greifswald
,
G. Schulte-Altedorneburg
5   Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum München-Harlaching
,
M. Köhrmann
6   Neurologische Klinik, Universitätsklinikum Erlangen
,
M. Nedelmann
7   Klinik für Neurologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
,
F. Schlachetzki
8   Klinik für Neurologie, Universität Regensburg, Bezirksklinikum Regensburg
› Author Affiliations
Further Information

Publication History

14 November 2011

20 February 2012

Publication Date:
14 June 2012 (online)

Lernziele

  1. Grundlagen der B-Bild-Sonografie, der Duplex-Sonografie und von Ultraschallkontrastmitteln in der Anwendung für die neurologische Notfall- und Intensivmedizin.

  2. Vaskuläre Diagnostik beim akuten Schlaganfall.

  3. Monitoring von Schlaganfallpatienten bei/nach Schlaganfall (spezifische Therapie einschließlich Thrombolyse, mechanischer Thrombektomie, Detektion von Mikroembolien und Detektion sowie Monitoring von Vasospasmen).

 
  • Literatur

  • 1 Dussik KT, Dussik F, Wyt L. Auf dem Wege zur Hyperphonographie des Gehirnes. Wien Med Wochenschr 1947; 97: 425-429
  • 2 Harrer JU, Tsivgoulis G. Transcranial sonography for monitoring hydrocephalus: an underestimated imaging modality. Neurology 2011; 76: 852-853
  • 3 Gerriets T, Goertler M, Stolz E et al. Feasibility and validity of transcranial duplex sonography in patients with acute stroke. J Neurol Neurosurg Psychiatry 2002; 73: 17-20
  • 4 Gerriets T, Stolz E, Konig S et al. Sonographic monitoring of midline shift in space-occupying stroke: an early outcome predictor. Stroke 2001; 32: 442-447
  • 5 Baumgartner RW, Baumgartner IB. Transcranial Doppler and color duplex ultrasound. Familiar and new uses. Ultraschall in Med 1996; 17: 50-54
  • 6 Eyding J, Geier B, Staub D. Current Strategies and Possible Perspectives of Ultrasonic Risk Stratification of Ischemic Stroke in Internal Carotid Artery Disease. Ultraschall in Med 2011; 32: 267-273
  • 7 Nedelmann M, Stolz E, Gerriets T et al. Consensus recommendations for transcranial color-coded duplex sonography for the assessment of intracranial arteries in clinical trials on acute stroke. Stroke 2009; 40: 3238-3244
  • 8 Wunderlich MT, Goertler M, Postert T et al. Recanalization after intravenous thrombolysis: does a recanalization time window exist?. Neurology 2007; 68: 1364-1368
  • 9 Droste DW, Kaps M, Navabi DG et al. Ultrasound contrast enhancing agents in neurosonology: principles, methods, future possibilities. Acta Neurol Scand 2000; 102: 1-10
  • 10 Claudon M, Cosgrove D, Albrecht T et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008. Ultraschall in Med 2008; 29: 28-44
  • 11 Harrer JU, Valaikiene J, Koch H et al. Transcranial perfusion sonography using a low mechanical index and pulse inversion harmonic imaging: reliability, inter-/intraobserver variability. Ultraschall in Med 2011; 32: S95-S101 DOI: 10.1055/s-0029-1245369.
  • 12 Seidel G, Claassen L, Meyer K et al. Evaluation of blood flow in the cerebral microcirculation: analysis of the refill kinetics during ultrasound contrast agent infusion. Ultrasound Med Biol 2001; 27: 1059-1064
  • 13 Meairs S, Alonso A. Ultrasound, microbubbles and the blood-brain barrier. Prog Biophys Mol Biol 2007; 93: 354-362
  • 14 Mariak Z, Krejza J, Swiercz M et al. Human brain temperature in vivo: lack of heating during color transcranial Doppler ultrasonography. J Neuroimaging 2001; 11: 308-312
  • 15 Schlosser HG, Doepp F, Nolte CH et al. Does routine transcranial duplex ultrasound heat up the patient brain?. Ultraschall in Med 2009; 30: 37-41
  • 16 Walter U, Kirsch M, Wittstock M et al. Transcranial Sonographic Localization of Deep Brain Stimulation Electrodes Is Safe, Reliable and Predicts Clinical Outcome. Ultrasound Med Biol 2011; 37: 1382-1391
  • 17 Huang Y, Hynynen K. MR-guided focused ultrasound for brain ablation and blood-brain barrier disruption. Methods Mol Biol 2011; 711: 579-593
  • 18 Administration. FaD. Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers. Rockville, MD, USA: Center for Devices and Radiological Health, US Food and Drug Administration; 1997
  • 19 Miller DL, Quddus J. Diagnostic ultrasound activation of contrast agent gas bodies induces capillary rupture in mice. Proc Natl Acad Sci U S A 2000; 97: 10179-10184
  • 20 Skyba DM, Price RJ, Linka AZ et al. Direct in vivo visualization of intravascular destruction of microbubbles by ultrasound and its local effects on tissue. Circulation 1998; 98: 290-293
  • 21 Rott HD. Safety of ultrasonic contrast agents. European Committee for Medical Ultrasound Safety. Eur J Ultrasound 1999; 9: 195-197
  • 22 Schlachetzki F, Holscher T, Koch HJ et al. Observation on the integrity of the blood-brain barrier after microbubble destruction by diagnostic transcranial color-coded sonography. J Ultrasound Med 2002; 21: 419-429
  • 23 Arning C, Widder B, von Reutern GM et al. Revision of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement. Ultraschall in Med 2010; 31: 251-257
  • 24 Jahromi AS, Cina CS, Liu Y et al. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: a systematic review and meta-analysis. J Vasc Surg 2005; 41: 962-972
  • 25 Postert T, Braun B, Meves S et al. Contrast-enhanced transcranial color-coded sonography in acute hemispheric brain infarction. Stroke 1999; 30: 1819-1826
  • 26 Eyding J, Krogias C, Schollhammer M et al. Contrast-enhanced ultrasonic parametric perfusion imaging detects dysfunctional tissue at risk in acute MCA stroke. J Cereb Blood Flow Metab 2006; 26: 576-582
  • 27 Fujimoto S, Toyoda K, Inoue T et al. Diagnostic impact of transcranial color-coded real-time sonography with echo contrast agents for hyperperfusion syndrome after carotid endarterectomy. Stroke: a journal of cerebral circulation 2004; 35: 1852-1856
  • 28 Alexandrov AV, Demchuk AM, Burgin WS et al. Ultrasound-enhanced thrombolysis for acute ischemic stroke: phase I. Findings of the CLOTBUST trial. J Neuroimaging 2004; 14: 113-117
  • 29 Eggers J, Konig IR, Koch B et al. Sonothrombolysis with transcranial color-coded sonography and recombinant tissue-type plasminogen activator in acute middle cerebral artery main stem occlusion: results from a randomized study. Stroke 2008; 39: 1470-1475
  • 30 Nedelmann M, Ritschel N, Doenges S et al. Combined contrast-enhanced ultrasound and rt-PA treatment is safe and improves impaired microcirculation after reperfusion of middle cerebral artery occlusion. J Cereb Blood Flow Metab 2010; 30: 1712-1720
  • 31 Tsivgoulis G, Eggers J, Ribo M et al. Safety and efficacy of ultrasound-enhanced thrombolysis: a comprehensive review and meta-analysis of randomized and nonrandomized studies. Stroke 2010; 41: 280-287
  • 32 Eggers J, Seidel G, Koch B et al. Sonothrombolysis in acute ischemic stroke for patients ineligible for rt-PA. Neurology 2005; 64: 1052-1054
  • 33 Molina CA, Ribo M, Rubiera M et al. Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke 2006; 37: 425-429
  • 34 White H, Venkatesh B. Applications of transcranial Doppler in the ICU: a review. Intensive Care Med 2006; 32: 981-994
  • 35 Klotzsch C, Nahser HC, Fischer B et al. Visualisation of intracranial aneurysms by transcranial duplex sonography. Neuroradiology 1996; 38: 555-559
  • 36 Griewing B, Motsch L, Piek J et al. Transcranial power mode Doppler duplex sonography of intracranial aneurysms. J Neuroimaging 1998; 8: 155-158
  • 37 Turner CL, Higgins JN, Gholkar A et al. Intracranial aneurysms treated with endovascular coils: detection of recurrences using unenhanced and contrast-enhanced transcranial color-coded duplex sonography. Stroke 2005; 36: 2654-2659
  • 38 Weyer GW, Nolan CP, Macdonald RL. Evidence-based cerebral vasospasm management. Neurosurg Focus 2006; 21: E8
  • 39 Aaslid R. Cerebral autoregulation and vasomotor reactivity. Front Neurol Neurosci 2006; 21: 216-228
  • 40 Grosset DG, Straiton J, McDonald I et al. Use of transcranial Doppler sonography to predict development of a delayed ischemic deficit after subarachnoid hemorrhage. J Neurosurg 1993; 78: 183-187
  • 41 Krejza J, Mariak Z, Walecki J. Usefulness of transcranial color-coded sonography in the diagnosis of cerebral vasospasm. Stroke 1999; 30: 2240-2241
  • 42 Aaslid R. Transcranial Doppler assessment of cerebral vasospasm. Eur J Ultrasound 2002; 16: 3-10
  • 43 Romano JG, Rabinstein AA, Arheart KL et al. Microemboli in aneurysmal subarachnoid hemorrhage. J Neuroimaging 2008; 18: 396-401
  • 44 Ionita CC, Graffagnino C, Alexander MJ et al. The value of CT angiography and transcranial doppler sonography in triaging suspected cerebral vasospasm in SAH prior to endovascular therapy. Neurocrit Care 2008; 9: 8-12
  • 45 Markus HS, Tegeler CH. Experimental aspects of high-intensity transient signals in the detection of emboli. J Clin Ultrasound 1995; 23: 81-87
  • 46 Ringelstein EB, Droste DW, Babikian VL et al. Consensus on microembolus detection by TCD. International Consensus Group on Microembolus Detection. Stroke 1998; 29: 725-729
  • 47 Dittrich R, Ringelstein EB. Occurrence and clinical impact of microembolic signals during or after cardiosurgical procedures. Stroke 2008; 39: 503-511
  • 48 Ritter MA, Dittrich R, Thoenissen N et al. Prevalence and prognostic impact of microembolic signals in arterial sources of embolism. A systematic review of the literature. J Neurol 2008; 255: 953-961
  • 49 Markus HS, King A, Shipley M et al. Asymptomatic embolisation for prediction of stroke in the Asymptomatic Carotid Emboli Study (ACES): a prospective observational study. Lancet Neurol 2010; 9: 663-671
  • 50 Wong KS, Chen C, Fu J et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 2010; 9: 489-497
  • 51 Markus HS, Droste DW, Kaps M et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005; 111: 2233-2240
  • 52 Toms DA. The mechanical index, ultrasound practices, and the ALARA principle. J Ultrasound Med 2006; 25(4): 560-561
  • 53 Sloan MA, Burch CM, Wozniak MA et al. Transcranial Doppler detection of vertebrobasilar vasospasm following subarachnoid hemorrhage.. Stroke 1994; 25: 2187-2197