title: Advances in transcranial Doppler clinical applications.
abstract: BACKGROUND
  Diagnostic neurosonology techniques including transcranial Doppler (TCD), transcranial color Doppler imaging (TCDI) and power motion-mode (PMD) TCD provide information about various aspects of cerebrovascular status such as microemboli detection, dynamic autoregulation and long-duration real-time monitoring of flow characteristics. Although most of the information provided cannot be obtained by any other imaging methodology, and is critical in clinical decision-making in the care of various neurovascular diseases, these modalities are widely underutilized. Increasing the familiarity to neurosonological techniques is of crucial importance.
  
  
  METHODS
  After briefly reviewing TCD, TCDI and PMD techniques, classical features are summarized and recent developments in the clinical neurosonology applications with specific interest in the neurovascular disorders.
  
  
  RESULTS
  Practical perspectives of ultrasound evaluation of intracranial arterial status in various neurovascular diseases including sickle cell vasculopathy and vasospasm are reviewed in detail. Pearls on the neurosonological monitoring of acute ischemic stroke and increased intracranial pressure increase is provided. Standards of cerebral microembolism detection, right to left shunts diagnosis and cerebral autoregulation assessment are discussed methodologically. Future perspectives of therapeutic neurosonology including sonothrombolysis, microbubble-ultrasound-mediated gene and drug delivery into the brain, and alteration of the brain-blood barrier permeability are summarized.
  
  
  CONCLUSIONS
  Suitable with future medicine, neurosonology brings imaging to the bedside, which enables the treating physician to monitor a given intervention in real time. A non-invasive neurosonology-guided treatment of various diseases could be possible in the near future. The first and foremost step in gaining mastery in this very fruitful field is beginning to use it.
authors.affiliation: Hacettepe University Hospitals, Department of Neurology, Neurological Intensive Care Unit, 06100, Sihhiye, Ankara, Turkey +90 312 3051806 ; +90 312 3093451 ; matopcuoglu@yahoo.com.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Topcuoglu
authors.forename: Ali
authors.initials: A
authors.lastname: Unal
authors.forename: Ethem Murat
authors.initials: EM
authors.lastname: Arsava