Neurosonology and Neuroimaging of Stroke Book / DVD PDF
Preview Neurosonology and Neuroimaging of Stroke Book / DVD
RV Neurosonology and oa el d h u l /e Kz la Neuroimaging of Stroke i The essentials in n/S gc eh cerebrovascular br ie e i lb disease management e r Neurosonology is a key modality in diagnosis and management of cerebrovascular N José M. Valdueza e disease and especially of stroke. Now, in this book, this non-invasive, real time u imaging method is placed firmly in the clinical context. r Stephan J. Schreiber o s o Jens-Eric Roehl This book offers both an outstanding overview of the principles of neurosonology and n o a casebook posing interesting angiologic questions. Ultrasound anatomy, technical l Randolf Klingebiel o aspects of clinical application, and the advantages and limitations of ultrasound are g y reviewed with reference to conventional angiography, MR and CT angiography. Thirty a selected cases from the authors’ extensive experience gained at the Department of n d Neurology at the Charité University Hospital, Berlin, Germany are then discussed. The N patient history and initial hypothesis are followed by detailed assessment of the extra- e u and intracranial color-coded duplex sonography findings and additional diagnostic r o procedures. Videos of the same cases on the DVD provide insight into the diagnostic i m method. a g i Features: n g • Complete extra- and intracranial arterial and venous ultrasound examination o • More than 750 high-quality illustrations, including full-color Doppler images f S • 30 selected clinical cases graded from easy to difficult in terms of t r neurosonologic complexity o k • DVD with almost 100 videoclips brings ultrasound anatomy and real cases e right to your screen! Neurosonology and Neuroimaging of Stroke offers neurologists, neuroradiologists, and all physicians treating patients with cerebrovascular disease an authoritative guide to this indispensable diagnostic tool. ISBN 978-3-13-141871-5 MediaCenter.thieme.com plus e-content online www.thieme.com VVaalldduueezzaa__SSttrrookkee__114411887711 11 0099..0044..22000088 1100::2266::4499 UUhhrr Neurosonology and Neuroimaging of Stroke José M. Valdueza, MD ProfessorofNeurology DirectorCenterofNeurology SegebergerClinicGroup BadSegeberg,Germany Stephan J. Schreiber, MD SeniorNeurologist DepartmentofNeurology CharitéUniversityHospital Berlin,Germany Jens-Eric Roehl, MD Neurologist DepartmentofNeurology CharitéUniversityHospital Berlin,Germany Randolf Klingebiel, MD HeadofDepartmentofNeuroradiology CharitéUniversityHospital Berlin,Germany 766illustrations Thieme Stuttgart·NewYork LibraryofCongressCataloging-in-PublicationData Importantnote:Medicineisanever-changingscienceundergoing continualdevelopment.Researchandclinicalexperiencearecontin- Neurosonologyandneuroimagingofstroke/JoséM. ually expanding our knowledge, in particular our knowledge of Valdueza...[etal.]. propertreatmentanddrugtherapy.Insofarasthisbookmentions p.;cm. anydosageorapplication,readersmayrestassuredthattheauthors, Includesbibliographicalreferencesandindex. editors,andpublishershavemadeeveryefforttoensurethatsuch ISBN978-3-13-141871-5(alk.paper) referencesareinaccordancewiththestateofknowledgeatthetime 1. Cerebrovasculardisease--Ultrasonicimaging--Atlases.2. Cere- ofproductionofthebook. brovasculardisease--Ultrasonicimaging--Casestudies. I.Valdueza, Nevertheless,thisdoesnotinvolve,imply,orexpressanyguaran- JoséM. teeorresponsibilityonthepartofthepublishersinrespecttoany [DNLM:1. CerebrovascularDisorders--radiography--Atlases.2. dosageinstructionsandformsofapplicationsstatedinthebook. CerebrovascularDisorders--radiography--CaseReports.3. Cerebro- Everyuserisrequestedtoexaminecarefullythemanufacturers’leaf- vascularDisorders--ultrasonography--Atlases.4. Cerebrovascular letsaccompanyingeachdrugandtocheck,ifnecessaryinconsulta- Disorders--ultrasonography--CaseReports.5. CerebralAngiogra- tionwithaphysicianorspecialist,whetherthedosageschedules phy--methods--Atlases.6. CerebralAngiography--methods--Case mentionedthereinorthecontraindicationsstatedbythemanufac- Reports.7. CerebrovascularCirculation--Atlases.8. Cerebrovascular turersdifferfromthestatementsmadeinthepresentbook.Such Circulation--CaseReports. WL17N49352008] examination is particularly important with drugs that are either RC388.5.N46342008 rarelyusedorhavebeennewlyreleasedonthemarket.Everydosage 616.8'107543--dc22 scheduleoreveryformofapplicationusedisentirelyattheuser’s 2008007225 own risk and responsibility. The authors and publishers request everyusertoreporttothepublishersanydiscrepanciesorinaccura- ciesnoticed.Iferrorsinthisworkarefoundafterpublication,errata willbepostedatwww.thieme.comontheproductdescriptionpage. ©2008GeorgThiemeVerlag, Someoftheproductnames,patents,andregistereddesignsreferred Rüdigerstrasse14,70469Stuttgart,Germany tointhisbookareinfactregisteredtrademarksorproprietarynames http://www.thieme.de eventhoughspecificreferencetothisfactisnotalwaysmadeinthe ThiemeNewYork,333SeventhAvenue, text.Therefore,theappearanceofanamewithoutdesignationas NewYork,NY10001,USA proprietaryisnottobeconstruedasarepresentationbythepub- http://www.thieme.com lisherthatitisinthepublicdomain. Thisbook,includingallpartsthereof,islegallyprotectedbycopy- Coverdesign:ThiemePublishingGroup right.Anyuse,exploitation,orcommercializationoutsidethenarrow TypesettingbyPrimustypeHurler,Notzingen,Germany limitssetbycopyrightlegislation,withoutthepublisher’sconsent,is PrintedbyDruckereiGrammlich,Pliezhausen,Germany illegalandliabletoprosecution.Thisappliesinparticulartophoto- statreproduction,copying,mimeographing,preparationofmicro- ISBN 978-3-13-141871-5 123456 films,andelectronicdataprocessingandstorage. V Foreword Ultrasoundhasundoubtedlychangedthefaceofmedicine gramsandimages.Theanatomy,pathology, andpatho- duringthepasttwodecades. Ultrasoundtestingissafe, physiology of the cervico-cranial arteries are discussed quick, and relatively inexpensive compared with other and illustrated in detail. Other vascular imaging techni- imagingmodalities.Tobeabletoperformmultiplerepeat ques(CTandMR angiographyanddyecontrastcatheter studiessafely hasmade ultrasound an ideal modality to angiography)arealsodiscussed,compared,andillustrated monitor various conditions and abnormalities. Echocar- indetailinPartA.Thequantity,quality,anddidacticutility diographyhasrevolutionizedcardiology,andsonography ofthediagrams,cartoons,andillustrationsisexceptional ofthepregnantuterushasbecomeindispensableforob- inmyexperience. stetrical care. Compared to ultrasound of the heart and The second part of the monograph (Part B) is unique. uterus,ultrasoundexplorationofthenervoussystemand Most individuals learn by example, the case method of itssupplyarteriesandveinsisarelativelynewfield.The teaching, rather than by general principles alone. Part B parts of the nervous system and the cervico-cranial ar- contains30casescenariosgroupedaccording totheex- teriesandveinsarequiteheterogeneousandanatomically pected difficulty of the neurosonology exploration and dispersed, making Neurosonology much more complex interpretation. The clinical findings are noted and the and diverse than insonating a single organ. While most imaging results are shown in detail. The discussions are cardiologistsandobstetricianshavebecomeveryfamiliar thoroughandmostusefulinunderstandingthetechniques with ultrasound use and images in their specialties, andresults.PartBhelpscliniciansandneuroradiologists neurosonologyisusedextensivelybyonlyveryfewneu- putintopracticalusetheprinciplesenunciatedinPartA. rologistsandneurosurgeons.Cerebrovascular specialists Part B also emphasizes potential difficulties and conun- have become familiar with neck and transcranial ultra- drums that are likely to confound even experienced soundreportsandresults,yetveryfewofthesesubspe- neurosonologists. cialistsactuallyperformorinterprettheexaminations.For Thisbookwilltakeprideofplaceonmylibraryshelfand thesereasonsthepresentmonographfulfillsalargevoid I anticipate using it often as a reference. It is a superb and willproveextremelyusefulfor neurologists,neuro- additiontotheliteratureonneurosonologyandofcere- surgeons,andneuroradiologistsandforallphysicianscar- brovascular diagnosisandmanagement. ingforpatientswithcerebrovascular diseases. This monograph is very systematically organized. The firstpart(A)containsthebasicprinciplesofneurosonol- LouisRCaplanMD ogyandofcerebrovascular disease.Ultrasoundprinciples ProfessorofNeurology,HarvardUniversity aredescribedandheavilyillustratedwithveryusefuldia- Boston,Massachusetts,USA VI Foreword Neurovascular disease, in particular stroke, has tremen- diseases ranging from acute stroke, arteritis and sinus douslycontributedtoNeurologydevelopingintoathera- venousthrombosistovascularmalformations. peuticspeciality.Today’scomplextreatmentstrategiesof Herebythebookoffersbeginnersaswellasexperienced acutestrokehavebeenestablishedthankstoinnumerable practitionerstheopportunitytoapproachultrasounddi- clinicalstudies.Thisrequiressophisticatedpathophysio- agnostics not only from the perspective of a specialized logicalanddetailedclinicalknowledgefromtheattending diagnosticianbutalsofromtheperspectiveofaclinician physician,asoftentheneuroanatomicalconditionaswell whoisstrugglingtogaintherelevantinformation.Itthere- asthefunctionalsituationareoftherapeuticrelevance. foreclosesagapinthecurrentlyavailableliteratureabout Variousdiagnosticmethodssuchasmagneticresonance theuseofneurosonologicalmethodsandatthesametime imaging, computed tomography, angiography as well as offersextensiveopportunitiesto“train”clinicaldiagnostic diagnosticultrasound,which istheonlybedsidetechni- thoughtsincerebrovasculardiseases. que,areincontinuousdevelopmentandcompetition. IamparticularlyproudthattheworkintheNeurological This book looks at competing and complementary DepartmentoftheCharitéUniversityTeachingHospitalin methods from the perspective of diagnostic ultrasound. Berlin,whereIhavebeenDirectorfor15years,ishonored One of the key issues of this book is the exploration of withthisbook.Icanhighlycommendtheauthorsofthis theadvantagesanddisadvantagesofthediagnostictools bookastheyhavebeenoutstandingcolleaguesandcom- usedincerebrovasculardiagnostics,theirspecificityand panionsformanyyears. sensitivityaswellastheirpitfalls.Inthefirstsection,the Igivemybestwishestothemandtheirbookwithits reader will find detailed and comprehensive text of the originalconcept,andIhopethatitwillquicklybecomea duplexultrasoundtechnique,includingpreciseandprag- standard text and reference source for many who work matic instructions, which will help the reader acquire a withinthespeciality,andbeyond. fundamentalunderstandingofNeurosonology. In the second, more extensive part of the book, the Prof.KarlM.Einhäupl clinicaladvantagesanddisadvantagesofvariousvascular ProfessorandChairman diagnosticmethodsaredemonstratedinrelationtoultra- DepartmentofNeurology sound, by means of 30 case histories. These have been CharitéUniversityHospital carefully selected from the wide field of neurovascular Berlin,Germany VII Table of Contents Part A Principles and Rules 1 FlowandUltrasoundBasics.................. 2 ParametersofCerebralHemodynamics........ 60 FlowDynamics............................. 2 CerebralBloodFlowVelocity............... 60 PhysicsofFlow........................... 2 ResistanceIndices ........................ 60 FlowPatternandFlowVelocity............. 2 CerebralBloodFlow ...................... 60 UltrasoundPrinciples....................... 3 CerebralCirculationTime.................. 61 DopplerEffect............................ 3 CerebralBloodVolume.................... 62 DopplerShiftandFlowVelocity ............ 4 UltrasoundSystems......................... 6 4 PathogenesisofStroke...................... 64 UltrasoundTransducer.................... 6 ArterialIschemia........................... 64 ImagingModalities,Parameters,andSettings 7 Pathophysiology.......................... 64 ClassificationofArterialStroke............. 65 2 VascularAnatomyandStructureofUltrasound MicroembolicSignals ....................... 72 Examination............................... 13 SpontaneousMicroemboli................. 72 GeneralArterialAnatomy.................... 13 DetectionofMicroemboliinPatentForamen ExtracranialArterialAnatomy.............. 13 Ovale ................................... 74 IntracranialArterialAnatomy .............. 15 VenousIschemia ........................... 74 GeneralStructureofArterialUltrasound Examination............................... 17 5 VascularPathology ......................... 76 SpecialArterialAnatomy VesselWallPathology....................... 76 andUltrasoundAnatomy.................... 18 Elongations.............................. 76 ExtracranialArteries...................... 18 Intima-mediaThickness................... 77 IntracranialArteries ...................... 24 AtheroscleroticPlaques.................... 78 GeneralVenousAnatomy.................... 40 Dissection............................... 80 IntracranialVenousAnatomy............... 41 FibromuscularDysplasia................... 80 ExtracranialVenousAnatomy.............. 42 Vasculitis................................ 81 GeneralStructureofVenousUltrasound StenosesandOcclusions..................... 81 Examination............................... 43 UltrasoundCriteriaofStenoses............. 81 SpecialVenousAnatomyandUltrasound UltrasoundCriteriaofOcclusions........... 85 Anatomy.................................. 43 ExtracranialPathology ...................... 86 IntracranialVeinsandSinuses.............. 43 ExtracranialAnteriorCirculation............ 86 ExtracranialVeins ........................ 49 ExtracranialPosteriorCirculation........... 91 IntracranialPathology....................... 94 3 IntracranialHemodynamicsandFunctional IntracranialAnteriorCirculation............ 96 Tests...................................... 54 IntracranialPosteriorCirculation ........... 99 Autoregulation............................. 55 CollateralPathways......................... 101 TestingofAutoregulation.................. 56 IntracranialCollateralPathways............ 101 NeurovascularCoupling..................... 56 IntracranialCollateralPathwaysinICA TestingofNeurovascularCoupling.......... 57 OcclusiveProcesses....................... 105 MetabolicCoupling......................... 57 IntracranialCollateralPathwaysinVA OtherTeststoAssessDifferencesBetweenthe OcclusiveProcesses....................... 108 RightandLeftSidesasMarkersofImpaired ExtracranialCollateralPathways............ 108 CollateralFunction........................ 59 ClinicalRelevanceofCollateralPathways.... 109 VIII TableofContents 6 AngiographicTechniquesinNeuroradiology .... 111 HistoricalDevelopment.................... 116 DigitalSubtractionAngiography............... 111 TechnicalAspects ......................... 116 HistoricalDevelopment.................... 111 StrengthsandDisadvantages ............... 117 TechnicalAspects ......................... 112 CurrentAlgorithmattheCharitéUniversity StrengthsandDisadvantages ............... 113 Hospital.................................... 119 MagneticResonanceAngiography............. 113 Stroke................................... 119 HistoricalDevelopment.................... 113 IntracranialAneurysm..................... 120 TechnicalAspects ......................... 114 Vasculitis................................. 121 StrengthsandDisadvantages ............... 115 CerebralVenousThrombosis................ 123 ComputedTomographicAngiography.......... 116 Peri-therapeuticImaging................... 124 Part B: Case Histories Case1 ExtracranialInternalCarotidArtery ConventionalAngiography ................... 143 Stenosis............................ 128 ClinicalCourse.............................. 144 ClinicalPresentation......................... 128 FinalDiagnosis.............................. 144 InitialNeuroradiologicFindings............... 128 Discussion ................................. 146 SuspectedDiagnosis......................... 128 QuestionstoAnswerbyUltrasoundTechniques . 128 Case5 M1MiddleCerebralArteryStenosis.... 149 InitialNeurosonologicFindings ............... 128 ClinicalPresentation......................... 149 ConventionalAngiography ................... 128 InitialNeuroradiologicFindings............... 149 ClinicalCourse.............................. 128 SuspectedDiagnosis......................... 149 FinalDiagnosis.............................. 130 QuestionstoAnswerbyUltrasoundTechniques . 149 Discussion ................................. 130 InitialNeurosonologicFindings(Day1) ........ 149 ConventionalAngiography(Day2) ............ 149 Case2 Free-floatingThrombusofthe FinalDiagnosis.............................. 150 ExtracranialInternalCarotidArtery .... 133 Discussion ................................. 151 ClinicalPresentation......................... 133 InitialNeuroradiologicFindings............... 133 Case6 P2PosteriorCerebralArteryStenosis... 156 SuspectedDiagnosis......................... 133 ClinicalPresentation......................... 156 QuestiontoAnswerbyUltrasoundTechniques .. 133 InitialNeuroradiologicFindings............... 156 InitialNeurosonologicFindings(Day1) ........ 133 SuspectedDiagnosis......................... 156 ClinicalCourse.............................. 133 QuestionstoAnswerbyUltrasoundTechniques . 156 NeurosonologicFindings(Day20)............. 134 InitialNeurosonologicFindings(Day2) ........ 156 FinalDiagnosis.............................. 134 ClinicalCourse.............................. 156 Discussion ................................. 135 FinalDiagnosis.............................. 157 Discussion ................................. 157 Case3 CommonCarotidArteryOcclusion ..... 138 ClinicalPresentation......................... 138 Case7 CerebralCirculatoryArrest............ 160 InitialNeuroradiologicFindings............... 138 ClinicalPresentation......................... 160 SuspectedDiagnosis......................... 138 InitialNeuroradiologicFindings............... 160 QuestionstoAnswerbyUltrasoundTechniques . 138 SuspectedDiagnosis......................... 160 InitialNeurosonologicFindings ............... 138 ClinicalCourse(1)........................... 160 ClinicalCourse.............................. 139 QuestiontoAnswerbyUltrasoundTechniques .. 160 FinalDiagnosis.............................. 141 InitialNeurosonologicFindings ............... 160 Discussion ................................. 142 CerebralCT................................. 160 ClinicalCourse(2)........................... 160 Case4 TemporalArteriovenousMalformation.. 143 FinalDiagnosis.............................. 162 ClinicalPresentation......................... 143 Discussion ................................. 162 InitialNeuroradiologicFindings............... 143 SuspectedDiagnosis......................... 143 Case8 BilateralIntracranialV4Vertebral QuestionstoAnswerbyUltrasoundTechniques . 143 ArteryStenosis...................... 165 InitialNeurosonologicFindings ............... 143 ClinicalPresentation......................... 165 TableofContents IX InitialNeuroradiologicFindings .............. 165 ClinicalPresentation........................ 194 SuspectedDiagnosis ........................ 165 InitialNeuroradiologicFindings .............. 194 ConventionalAngiography(Day1)............ 165 SuspectedDiagnosis ........................ 194 ClinicalCourse(1).......................... 165 QuestionstoAnswerbyUltrasoundTechniques. 194 QuestiontoAnswerbyUltrasoundTechniques.. 165 InitialNeurosonologicFindings............... 194 InitialNeurosonologicFindings(Day42)....... 165 ConventionalAngiography................... 195 NeuroradiologicFindings.................... 166 ClinicalCourse............................. 195 ClinicalCourse(2).......................... 168 FinalDiagnosis............................. 196 FinalDiagnosis............................. 168 Discussion................................. 200 Discussion................................. 168 Case13 InternalCarotidArteryStenosisin Case9 MoyamoyaDiseasewithBilateral FibromuscularDysplasiaand Carotid-TStenosis................... 171 WegenerGranulomatosis ........... 204 ClinicalPresentation........................ 171 ClinicalPresentation........................ 204 InitialNeuroradiologicFindings .............. 171 InitialNeuroradiologicFindings .............. 204 SuspectedDiagnosis ........................ 171 SuspectedDiagnosis ........................ 204 QuestionstoAnswerbyUltrasoundTechniques. 171 QuestiontoAnswerbyUltrasoundTechniques.. 204 InitialNeurosonologicFindings(Day1)........ 171 InitialNeurosonologicFindings(Day1)........ 204 ConventionalAngiography(Day2)............ 171 ClinicalCourse(1).......................... 204 ClinicalCourse............................. 173 ConventionalAngiography(Day5)............ 205 FinalDiagnosis............................. 173 ClinicalCourse(2).......................... 205 Discussion................................. 173 Follow-upNeurosonologicFindings(5Years)... 205 FinalDiagnosis............................. 206 Case10 ThrombolysisofM1MiddleCerebral Discussion................................. 207 ArteryOcclusion................... 176 ClinicalPresentation........................ 176 Case14 IsolatedCarotidSiphonStenosis ..... 210 InitialNeuroradiologicFindings .............. 176 ClinicalPresentation........................ 210 SuspectedDiagnosis ........................ 176 InitialNeuroradiologicFindings .............. 210 ClinicalCourse(1).......................... 176 SuspectedDiagnosis ........................ 210 QuestionstoAnswerbyUltrasoundTechniques. 176 QuestionstoAnswerbyUltrasoundTechniques. 210 InitialNeurosonologicFindings............... 176 InitialNeurosonologicFindings............... 210 ClinicalCourse(2).......................... 176 ClinicalCourse............................. 210 Follow-upNeurosonologicFindings(1Hour)... 176 FinalDiagnosis............................. 211 ClinicalCourse(3).......................... 177 Discussion................................. 213 FinalDiagnosis............................. 177 Discussion................................. 178 Case15 NearOcclusionoftheExtracranial InternalCarotidArtery.............. 215 Case11 SecondaryOcclusioninInternalCarotid ClinicalPresentation........................ 215 ArteryDissection ..................... 183 InitialNeuroradiologicFindings .............. 215 ClinicalPresentation........................ 183 SuspectedDiagnosis ........................ 215 InitialNeuroradiologicFindings .............. 183 QuestionstoAnswerbyUltrasoundTechniques. 215 SuspectedDiagnosis ........................ 183 InitialNeurosonologicFindings............... 215 QuestionstoAnswerbyUltrasoundTechniques. 183 ConventionalAngiography................... 216 InitialNeurosonologicFindings(Day1)........ 183 ClinicalCourse(1).......................... 216 ClinicalCourse(1).......................... 183 Follow-upNeurosonologicFindings(2Months). 216 QuestionstoAnswerbyUltrasoundTechniques. 184 ClinicalCourse(2).......................... 216 Follow-upNeurosonologicFindings(Day2).... 184 Follow-upNeurosonologicFindings(5Months). 216 ClinicalCourse(2).......................... 184 FinalDiagnosis............................. 216 Follow-upNeurosonologicFindings(Day7).... 184 Discussion................................. 222 ClinicalCourse(3).......................... 184 Follow-upNeurosonologicFindings(6Months). 184 Case16 Giant-cellArteritiswithBilateral FinalDiagnosis............................. 185 IntracranialV4VertebralArtery Discussion................................. 190 Stenosis .......................... 225 ClinicalPresentation........................ 225 Case12 BilateralProximalExtracranialInternal InitialNeuroradiologicFindings .............. 225 CarotidArteryOcclusionandHigh- SuspectedDiagnosis ........................ 225 gradeV1VertebralArteryStenosis... 194 QuestionstoAnswerbyUltrasoundTechniques. 225
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