Stroke, Vol 24, 1519-1527, Copyright © 1993 by American Heart Association
G Seidel, M Kaps and W Dorndorf
BACKGROUND AND PURPOSE: It is well established from pediatric experience
and animal experiments that intracerebral blood can be demonstrated by
B-mode real-time duplex scanning. This has recently become feasible in
adults as well. The present study investigated the changes in the
sonographic appearance of intracerebral hematomas over the course of time.
METHODS: Starting in May 1991, 23 consecutive patients with intracerebral
hematoma confirmed by computed tomography (21 spontaneous and 2 traumatic
hematomas) were investigated within 1 year. They were monitored by repeated
ultrasound scanning via the transtemporal approach. The sonographic
appearance of the hematomas on B-mode scans and the angle-corrected blood
flow velocity in the basal cerebral arteries were assessed. RESULTS: There
was unequivocal localization of the hematoma in 18 patients (78%). In 3
cases (13%), an adequate acoustic window could not be found. One small
intracerebral hemorrhage was overlooked, and one extensive hemorrhage in
the basal ganglia was misdiagnosed as a lobar hematoma. There was an
alteration of the appearance of the hematoma with time. This was divided
into three sonographic stages (initial stage, days 1 to 5; intermediate
stage, days 6 to 10; and capsular stage, from day 10). In 14 of the 20
patients with an appropriate acoustic bony echo window, the blood flow
velocity in the middle cerebral artery could be measured; in 1 of these
patients, the signs of increasing intracranial pressure were apparent from
Doppler frequency spectrum. In 5 patients, the intracerebral hematoma could
be imaged but not the ipsilateral middle cerebral artery. One female
patient showed cerebral circulatory arrest at the time of examination,
which took place within 24 hours after the onset of clinical symptoms.
CONCLUSIONS: Most intracerebral hematomas in adults can be imaged in
B-mode. Their sonographic appearance changes over the course of the
disease. The advantages of this noninvasive method are its easy bedside
operation and its suitability for follow- up; it is also less stressful
than other imaging procedures. It yields a combination of structural and
functional diagnostic information. In approximately 13% of the cases, the
investigation was not feasible because of inadequate ultrasonic penetration
of the intact skull.
ARTICLES
Transcranial color-coded duplex sonography of intracerebral hematomas in adults
Department of Neurology, Justus-Liebig-Universitat, Giessen, Germany.
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