title: Right-to-left-shunt detected by c-TCD using the orbital window in comparison with temporal bone windows.
abstract: OBJECTIVE
  There have been some reports on right-to-left shunt as a cause of cryptogenic stroke. Although contrast transcranial Doppler (c-TCD) can detect RLS, an insufficient temporal window has occasionally restricted its applicability. Thus, we compared the rates of detecting RLS among temporal windows for the middle cerebral arteries (MCAs) and the orbital window for the internal carotid artery (ICA) on c-TCD.
  
  
  METHODS
  We used c-TCD to detect RLS in patients with suspected ischemic stroke. We enrolled patients who had both sufficient bilateral temporal windows for MCAs and a right orbital window for ICA and performed c-TCD using all three windows simultaneously.
  
  
  RESULTS
  We enrolled 106 consecutive patients and identified microembolic signals (MES) in 30 (28%) of them. Among these 30 patients, 15 had MES from all 3 windows. When these 30 patients were defined as being positive for RLS, the rates of detection were 67%, 73%, and 80% from the right temporal, left temporal, and right orbital windows, respectively (P= .795).
  
  
  CONCLUSIONS
  The right orbital window as well as the temporal window for c-TCD could detect RLS. Insonation from the orbital window should be useful for patients who lack temporal windows.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan. k.koba@hotmail.co.jp
authors.forename: Kazuto
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
authors.forename: Kenichirou
authors.initials: K
authors.lastname: Sakai
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwanaga
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
mesh_terms: D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013701:Temporal Bone / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*