title: Transcranial sonographic monitoring of hemorrhagic transformation in patients with acute middle cerebral artery infarction.
abstract: OBJECTIVE
  Previous studies indicate the potential of transcranial sonography (TCS) to detect cerebrovascular disease. The authors conducted this patient study to evaluate the diagnostic potential of gray-scale TCS in depicting hemorrhagic transformation (HT) in the early phase of middle cerebral artery infarction.
  
  
  METHODS
  TCS was performed in 32 patients with acute ischemic stroke in the middle cerebral artery territory less than 12, 24 +/- 4, 72 +/- 6, and 120 +/- 12 hours after symptom onset (SONOS 5500, S4 probe, 16 cm investigation depth). Hemorrhagic transformation was identified as hyperechogenicity in the MCA territory, and the echogenicity of these areas was assessed. In addition, the dislocation of the third ventricle (midline shift, MLS) was assessed by TCS. Size and localization of infarction were determined by cranial computed tomography (CCT).
  
  
  RESULTS
  In 10 of 11 patients, TCS detected HT as confirmed by CCT. In 1 patient, TCS provided a false-positive result. In another patient, TCS was unable to detect the hemorrhage (sensitivity, 91%; specificity, 95%). The echointensity of HT increased over time. MLS measurement failed to predict fatal outcome in 1 patient.
  
  
  CONCLUSIONS
  TCS is a promising tool for depicting HT in patients with acute hemispheric stroke and might be suitable for monitoring purposes.
authors.affiliation: University Hospital Schleswig-Holstein, Campus Lübeck, Department of Neurology, Ratzeburger Allee 160, D-23538 Lübeck, Germany. guenter.seidel@neuro.uni-luebeck.de
authors.forename: Günter
authors.initials: G
authors.lastname: Seidel
authors.forename: Hakan
authors.initials: H
authors.lastname: Cangür
authors.forename: Thomas
authors.initials: T
authors.lastname: Albers
authors.forename: Karsten
authors.initials: K
authors.lastname: Meyer-Wiethe
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial