ABSTRACT
Stroke is a major social and health-care burden, with more than 700,000 people suffering from it annually in the United States. It is the leading cause of permanent disability, and its annual cost to patients, hospitals, and society is estimated at $51 billion ( 1 ). Cerebrovascular ultrasound has established applications in the detection of stroke risk factors and mechanisms; in screening for therapeutic, surgical, and catheter-based interventions; and in monitoring of arterial lesions that are responsible for stroke symptoms. Ultrasound provides a fast, portable, noninvasive, repeatable, and inexpensive technique for vascular diagnosis. Ultrasound in stroke care directly affects clinical decision-making in the following situations ( 2 ):
● Early detection, quantifi cation, and characterization of extracranial atherosclerosis and occlusive disease, especially at the carotid bifurcation
● Consequences of proximal arterial occlusive disease on the distal cerebral vasculature ● Detection of microemboli associated with cardiac and aortic pathology and carotid artery
surgical manipulation (and perhaps gauging response to antiplatelet therapy) ● Selection of children with sickle cell disease for blood transfusion as an effective tool in
primary stroke prevention ● Natural history and response to treatment of acute arterial occlusion that causes hyperacute
stroke ● Augmentation of the fi brinolytic effect of thrombolytic drugs in the treatment of acute
is chemic stroke ● Time course and reversibility of cerebral vasospasm after subarachnoid hemorrhage
This chapter describes the use of cerebrovascular ultrasound tests at bedside for patients with acute stroke symptoms. Vascular ultrasound assessment has evolved as an extension of the neurologic examination that helps to defi ne vascular origin of patient symptoms and location of arterial obstruction to fl ow.
