Usefulness of Transcranial Color-Doppler in the Etiologic Diagnosis of Acute Ischemic Stroke

Purpose: To evaluate if transcranial color-Doppler (TCD) in addiction to the common sonographic examinations (echo-color Doppler of the carotid tree, transthoracic and/or transesophageal echocardiography) brings to a more accurate etiologic diagnosis in patient with acute ischemic stroke. Methods and Materials: Twenty patients with acute ischemic stroke were enrolled. The patients underwent clinical evaluation in order to determine the location diagnosis according to Bamford classification and stroke severity according to NIHSS score. Moreover patients underwent basal brain CT and control brain CT after 48–72 hours, echo-color Doppler of the carotid tree, transthoracic and/or transesophageal echocardiography and TCD. TOAST etiologic classification was made in a first time without considering TCD results (TOAST-BAS) and in a second time adding TCD results (TOAST-TCD). Results: By TCD was evidenced a stenosis or occlusion of middle cerebral artery in 5 (25%) of 20 patients. In 4 of these the lesion was consensual with the side of stroke permitting the more accurate determination of etiological stroke class. Without considering TCD results (TOAST-BAS) the most probable cause of stroke was identified in 13 (65%) patients. Considering TCD results (TOAST-TCD) the most probable cause of stroke was identified in 16 (80%) patients. Conclusions: TCD bring to a better determination of the most probable cause of stroke.