Submandibular TCD approach detects post-bulb ICA stenosis in children with sickle cell anemia.
BACKGROUND
Transcranial Doppler (TCD) ultrasound is a procedure commonly used to screen individuals with the major hemoglobin S diseases, Hb SS and Hb S-beta(0), for significant stenoses in the circle of Willis. Flow velocities above 200 cm/s have been shown to identify patients at elevated risk for cerebral infarction. Among TCD's limitations is the inability to insonate the distal extracranial, petrous, and cavernous internal carotid artery (ICA) through the standard transtemporal approach.


METHODS
We extended the submandibular approach to include infra-siphon portions of the ICA.


RESULTS
Using the extended submandibular approach to evaluate these portions of the ICA, we identified stenotic lesions in 4 patients with Hb SS disease out of a population of 131 children with Hb SS. Three of the 4 patients had no history of overt stroke or stroke-like symptoms. Neuroimaging confirmed the stenotic lesions, and also revealed watershed infarction as well as discrete areas of silent infarction. All 4 children had neuropsychological impairment.


CONCLUSIONS
The submandibular approach, when added to a standard transcranial Doppler examination, may increase the sensitivity of this technique to identify important potential sources of cerebral infarction.
Gorman
Mark J
MJ
Stroke Program, Department of Neurology, University of Vermont, Given C219D, 89 Beaumont Avenue, Burlington, VT 05405-0068, USA. mgorman1@uvm.edu
Nyström
Karin
K
Carbonella
Judith
J
Pearson
Howard
H
D000293:Adolescent; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000150:complications*; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008334:Mandible / Q000033:anatomy & histology; D008403:Mass Screening / Q000379:methods; D009333:Neck / Q000033:anatomy & histology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*