Preliminary study of transcranial Doppler observation of cerebral herniation in acute internal carotid artery occlusion

Background and Purpose The purpose of this study was to attempt early detection of the risk of cerebral herniation after acute internal carotid artery occlusion (AICAO) using transcranial Doppler. Methods Twenty-four patients were enrolled within 6 hours of symptom onset. All patients underwent transcranial Doppler (TCD), head computed tomography (CT), magnetic resonance angiography (MRA) or computed tomography angiography (CTA). The National Institutes of Health Stroke Scale (NIHSS) score and the Alberta Stroke Program Early CT Score (ASPECTS) were performed in emergency department and 24 hours after the onset of acute ischemic stroke (AIS) (designated as NIHSS1 and ASPECTS1, respectively). TCD to determine collateral circulation was performed immediately after patient admission. Results Sex, risk factors, hemisphere, intravenous recombinant tissue plasminogen activator (rt-PA), and time from onset of symptoms to initiation treatment showed no difference between patients with or without cerebral herniation. The age of the group with cerebral hernia was significantly younger than that of the group without cerebral hernia (P=0.000). Assessment of the anterior communicating artery (ACoA) by TCD was in high agreement with assessment by MRA or CTA (kappa=0.625, P=0.002). Correlation analysis showed that the likelihood of a cerebral herniation event was positively correlated with absence of a communicating artery (r n =0.660, P=0.002) and negatively correlated with ACoA (r n =0.513, P=0.003) and ASPECTS1 (r s =0.528, P=0.008), but was not correlated with NIHSS score, NIHSS1 score, △NIHSS (NIHSS1-NIHSS), admission awareness, and stroke volume (P > 0.05). Conclusions TCD assessment of collateral status could more rapidly indicate the risk of cerebral herniation. Lack of collateral flow may predict the occurrence of cerebral hernia. Compensation of ACoA may indicate a lower risk of cerebral hernia.