title: Additional information given to a multimodal imaging stroke protocol by transcranial Doppler ultrasound in the emergency room: a prospective observational study.
abstract: BACKGROUND
  Transcranial Doppler (TCD) ultrasound can demonstrate dynamic information. We aimed to evaluate whether TCD generates useful additional information in the emergency room after a multimodal stroke imaging protocol and also whether this modified the management of patients with cerebral infarction.
  
  
  METHODS
  Patients admitted between April 2006 and June 2007 with ischemic stroke of less than 24 h were subjected to a protocol consisting of non-contrast brain CT, computed tomography angiography, diffusion-weighted magnetic resonance imaging and then TCD within the following 6 h by an observer blinded to the results of imaging studies.
  
  
  RESULTS
  Seventy-nine patients were included. The imaging protocol was performed 457 (+/-346) min after stroke symptoms and TCD after 572 (+/-376) min. TCD provided additional information in 28 cases (35.4%, 95% CI 25.7-46.4). More that one piece of additional information was obtained in 6 patients. The most frequent additional information was collateral pathways. Multivariate analysis demonstrated that intracranial vessel occlusion was the variable most associated with additional information. In 7 patients (8.8%, 95% CI 4.3-17.1), additional information changed management: in 4 an additional angiography was performed, in 2 patients angiography was suspended and in 1 aggressive neurocritical care was indicated. Patients with NIHSS >10 were significantly more likely to have their initial treatment changed (p = 0.004).
  
  
  CONCLUSIONS
  TCD can provide additional information to a multimodal acute ischemic stroke imaging protocol in a third of patients. This can result in changes in the management in some of these patients.
authors.affiliation: Cerebrovascular Program, Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Santiago, Chile. abrunser@alemana.cl
authors.forename: Alejandro M
authors.initials: AM
authors.lastname: Brunser
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Cárcamo
authors.forename: Arnold
authors.initials: A
authors.lastname: Hoppe
authors.forename: Verónica
authors.initials: V
authors.lastname: Olavarría
authors.forename: Violeta
authors.initials: V
authors.lastname: Diaz
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Rivas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial