Abstract
Flow disturbances in main cerebral arteries may cause severe neurological symptoms. Using transcranial Doppler sonography (TCD) the blood flow velocities in the basal cerebral arteries (BCA) can be recorded at any age. Transient stenoses or occlusions of main cerebral arteries were detected in 11 children by this method and confirmed by other techniques. Vasospasm produced a marked increase in flow velocities in the affected arteries which was reduced by nimodipine, the calcium channel blocker. Vasospasm also occurred in severe bacterial meningitis. In acute hemiplegia due to cerebral arterial obstruction no flow velocities could be recorded at the corresponding site. If distal branches were obstructed reduced flow velocities were found proximally. Increased flow velocities or reversed flow in anastomoses indicated the collateralization. The transient nature of the occlusions was shown by repcated recordings. TCD is a reliable, noninvasive and rapidly available technique for diagnosing or excluding transient flow disturbances in the main cerebral arteries as the cause of neurological symptoms in children. It indicates the necessity and most advantageous stage for therapy.
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Abbreviations
- ACA:
-
anterior cerebral artery
- BCA:
-
basal cerebral artery (-ies)
- CT:
-
computed tomography
- ICA:
-
internal carotid artery
- MCA:
-
middle cerebral artery
- MFV:
-
mean peak flow velocity
- PCA:
-
posterior cerebral artery
- TCD:
-
transcranial Doppler sonography
References
Aaslid R, Markwalder TM, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocities in basal cerebral arteries. J Neurosurg 57:769–774
Aaslid R, Huber P, Nornes H (1984) Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60: 37–41
Allen GS, Ahn HS, Preziosi TJ, Battye R (1983) Cerebral arterial spasm — a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 308:619–624
Auer LM (1984) Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:57–66
Bode H, Wais U (1988) Age-dependence of flow velocities in basal cerebral arteries. Arch Dis Child 63:606–611
Bode H, Straßburg HM, Pringsheim W, Künzer W (1986) Cerebral infarction in term neonates: diagnosis by cerebral ultrasound. Child's Nerv Syst 2:195–199
Bode H, Sauer M, Harders A (1987) Untersuchungen mit der transkraniellen Dopplersonographie bei einem Kind mit Moya-Moya-Erkrankung. In: Fichsel H (ed) Aktuelle Neuropädiatrie 1986. Springer, Berlin Heidelberg New York, pp 383–388
Cho C, Pruitt AW (1986) Therapeutic uses of calcium channelblocking drugs in the young. Am J Dis Child 140:360–366
Ferbert A, Zeumer H, Ringelstein EB (1985) Dopplersonographische Befunde beim ischämischen Hirninfarkt unterschiedlicher Pathogenese. Akt Neurol 12:153–157
Frantzen E, Jacobsen HH, Herkelsen J (1962) Cerebral artery occlusions in children due to trauma to the head and neck. Neurology 11:695
Fritsch G (1984) Acute infantile hemiplegia caused by cerebral ischemic infarction — etiology, clinical features and investigations. Padiatr Padol 19:287–301
Gaab MR, Rode CP, Schakel EH, Haubitz I, Bockhorn J (1985) The influence of the ca — antagonist nimodipine on regional and global cerebral blood flow. Klin Wochenschr 63:8–15
Greitz T (1964) Angiography in tuberculous meningitis. Acta Radiol [Diagn] (Stockh) 2:369–378
Harders A (1986) Neurosurgical applications of transranial Doppler sonography. Springer, Berlin Heidelberg New York
Igarashi M, Gilmartin RC, Gerald B, Wilburn F, Jabbour JT (1984) Cerebral arteriitis and bacterial meningitis. Arch Neurol 41:531–535
Isler W (1973) Obstruction of intracranial arteries in childhood. Neuropädiatrie 4:3–6
Kodama N, Mizoi K, Sakurai Y, Suzuki J (1980) Incidence and onset of vasospasm. In: Wilkins RA (ed) Cerebral arterial spasm. Williams and Wilkins, Baltimore London, pp 120–138
Kostron H, Twery K, Stampfl G, Mohsenipour I, Fischer J (1984) Treatment of the traumatic cerebral vasospasm with the calcium channel blocker nimodipine: a preliminary report. Neurol Res 6: 29–32
Leeds NE, Goldberg HI (1971) Angiographic manifestations incerebral inflammatory disease. Radiology 98:595–604
Mannino FL, Trauner A (1983) Stroke in neonates. J Pediatr 102: 605–610
Meyer CHA, Lowe D, Meyer M, Richardson PL, Neil-Dwyer G (1983) Progressive change in cerebral blood flow during the first three wecks after subarachnoid hemorrhage. Neurosurgery 12: 58–76
Ringelstein EB (1985) Transnuchale Diagnose intrakranieller vertebrobasilärer Stenosen mit Hilfe eines neuartigen Impulsschall-Doppler-Systems. Ultraschall Med 6:60–67
Ritchie WL, Overton TR (1980) Vasospasm and cerebral blood flow after subarachnoid hemorrhage. J Can Assoc Radiol 31:230–233
Scheffner, Wille L (1973) Acute infantile hemilegia due to obstruction of intracranial arterial vessels. Neuropädiatrie 4:7–9
Seiler RW, Aaslid R (1986) Transcranial Doppler for evaluation of cerebral vasospasm. In: Aaslid R (ed) Transcranial Doppler sonography. Springer, Berlin Heidelberg New York, pp 118–131
Yamashima T, Kashihara K, Ikea K, Kubota T, Yamamoto S (1985) Three phases of cerebral arteriopathy in meningitis: vasospasm and vasodilatation followed by organic stenosis. Neurosurgery 16:546–553
Zeumer H, Ringelstein EH, Hacke W (1983) Gefäßrekanalisierende Verfahren der interventionellen Neuroradiologie. Fortschr Röntgenstr 139:467–475
Zimmermann AW, Kumar AJ, Gadoth N, Hodges FJ (1978) Traumatic vertebrobasilar occlusive disease in childhood. Neurology 28:185
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Bode, H., Harders, A. Transient stenoses and occlusions of main cerebral arteries in children —diagnosis and control of therapy by transcranial Doppler sonography. Eur J Pediatr 148, 406–411 (1989). https://doi.org/10.1007/BF00595898
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DOI: https://doi.org/10.1007/BF00595898