title: [Ultrasonography in diagnosis and monitoring the progress of dissection of cervicocerebral arteries].
abstract: BACKGROUND
  Ultrasonography has become part of the arsenal of diagnostic methods available for examining the dissection of cerebral blood vessels (DCV).
  
  
  OBJECTIVE
  To analyse the value of ultrasonography in the diagnosis and monitoring of DCV.
  
  
  METHODS
  We conducted a consecutive study of 67 patients with a history and clinical picture compatible with DCV; all of them had been given confirmation of their diagnosis by another reference method (digital angiography or MR angiography) during the 48 hours prior to or following the ultrasound study. The ultrasonography was carried out on the neck and skull as per the usual system using continuous Doppler, neck duplex and transcranial Doppler ultrasonography. Diagnosis of the dissection was based on direct and indirect signs, in the absence of an atheroma plaque. The following were considered to be direct signs: haematoma in the wall of the vessel, flap, local increase in the flow velocity and echograms with split systole. Indirect signs were: haemodynamic alterations proximal to the dissection, a pattern of slow flow and high resistance. The transcranial Doppler showed the findings lying distal to the dissection to be a lowered mean velocity and pulsatility.
  
  
  RESULTS
  The ultrasonography of the series revealed direct signs in 46 patients (69%) and indirect signs in 21 (31%). Ultrasonography was used as the primary diagnostic method in 29 (43%) patients; in the other 38 (57%) it was employed to verify the diagnosis or for the follow up. All the ultrasound diagnoses were confirmed using digital angiography (21 cases) or magnetic resonance angiography (46 cases).
  
  
  CONCLUSIONS
  Due to its harmlessness, ultrasonography should be the first examination used to establish a probable diagnosis of DCV.
authors.affiliation: Instituto de Investigaciones Neurológicas Dr. Raúl Carrea, (FLENI), Buenos Aires, Argentina. lagos@fleni.org.ar
authors.forename: R
authors.initials: R
authors.lastname: Lagos-Grinstein
authors.forename: L
authors.initials: L
authors.lastname: Fernández-Cisneros
authors.forename: F
authors.initials: F
authors.lastname: Murillo-Cabezas
authors.forename: S
authors.initials: S
authors.lastname: Blanco García-Barroso
authors.forename: C
authors.initials: C
authors.lastname: Cejas-Archidamo
authors.forename: U
authors.initials: U
authors.lastname: Nobo-López
authors.forename: S F
authors.initials: SF
authors.lastname: Ameriso-Martínez
mesh_terms: D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000473:pathology; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis* / Q000473:pathology*; D002533:Cerebral Angiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial