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Abnormal flow in the cerebral arteries
Journal of Clinical Neuroscience 16 (2009) 1050
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
Abnormal flow in the cerebral arteries Vijay K. Sharma *, Quek K. Kia, Chiew S. Hong, Bernard P.L. Chan Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
1. Clinical background A 72-year-old woman underwent cervical duplex and transcranial Doppler (TCD) ultrasonography following an episode of transient left-sided weakness. She had been taking medications for hypertension for about 5 years but did not suffer from any other significant illness. She was fully conscious and communicative, walked independently and had a ‘collapsing’ pulse with a blood pressure of 130/30 mmHg. No focal neurological deficits were noted on clinical examination. MRI of the brain was unremarkable. Doppler spectra obtained on cervical duplex from both internal carotid arteries are shown in Figure 1(A, B). The TCD spectral patterns from both middle cerebral arteries (Fig. 1C, D), the basilar ar-
tery (Fig. 1E) and all other intracranial arteries demonstrated an abnormal pattern. 2. What may cause the abnormality seen in the Doppler spectra of the cervical and intracranial arteries? A. B. C. D.
Cerebral circulatory arrest (brain death). Extremely high intracranial pressure (ICP). Severe cardiac valvular disorder. All of the above.
Answer on page 1116.
Fig. 1. (A, B) Doppler spectral waveforms obtained from both internal carotid arteries (ICA) on cervical duplex sonography. (C–E) Doppler spectral waveforms obtained from both middle cerebral arteries (MCA) and the basilar artery (BA) on transcranial Doppler. This figure is available in colour at www.sciencedirect.com.
* Corresponding author. Tel.: +65 6772 4126; fax: +65 6872 3566. E-mail address: [email protected] (V.K. Sharma). 0967-5868/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2008.06.022
Contents lists available at ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
Abnormal flow in the cerebral arteries Vijay K. Sharma *, Quek K. Kia, Chiew S. Hong, Bernard P.L. Chan Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
1. Clinical background A 72-year-old woman underwent cervical duplex and transcranial Doppler (TCD) ultrasonography following an episode of transient left-sided weakness. She had been taking medications for hypertension for about 5 years but did not suffer from any other significant illness. She was fully conscious and communicative, walked independently and had a ‘collapsing’ pulse with a blood pressure of 130/30 mmHg. No focal neurological deficits were noted on clinical examination. MRI of the brain was unremarkable. Doppler spectra obtained on cervical duplex from both internal carotid arteries are shown in Figure 1(A, B). The TCD spectral patterns from both middle cerebral arteries (Fig. 1C, D), the basilar ar-
tery (Fig. 1E) and all other intracranial arteries demonstrated an abnormal pattern. 2. What may cause the abnormality seen in the Doppler spectra of the cervical and intracranial arteries? A. B. C. D.
Cerebral circulatory arrest (brain death). Extremely high intracranial pressure (ICP). Severe cardiac valvular disorder. All of the above.
Answer on page 1116.
Fig. 1. (A, B) Doppler spectral waveforms obtained from both internal carotid arteries (ICA) on cervical duplex sonography. (C–E) Doppler spectral waveforms obtained from both middle cerebral arteries (MCA) and the basilar artery (BA) on transcranial Doppler. This figure is available in colour at www.sciencedirect.com.
* Corresponding author. Tel.: +65 6772 4126; fax: +65 6872 3566. E-mail address: [email protected] (V.K. Sharma). 0967-5868/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2008.06.022