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From Rush University Medical Center (Dr. Sloan), Chicago, IL; University of Texas Houston Medical Center (Dr. Alexandrov); School of Medicine, Wake Forest University (Drs. Tegeler and Lefkowitz), Winston-Salem, NC; Institute of Applied Physiology and Medicine (Dr. Spencer), Seattle, WA; Beth Israel Deaconess Medical Center (Dr. Caplan), Boston, MA; School of Medicine, Brown University (Dr. Feldmann), Providence, RI; University of Pittsburgh Medical Center (Dr. Wechsler), PA; University of Washington (Dr. Newell), Seattle; Alabama Neurological Institute (Dr. Gomez), Birmingham; Boston University School of Medicine (Dr. Babikian), MA; Aurora Medical Group (Dr. Goldman), Milwaukee, WI; Baystate Medical Center (Dr. Armon), Springfield, MA; Washington University School of Medicine (Dr. Hsu), St. Louis, MO; and University of California at San Francisco (Dr. Goodin).
Address correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Ave, St. Paul, MN 55116.
Objective: To review the use of transcranial Doppler ultrasonography (TCD) and transcranial color-coded sonography (TCCS) for diagnosis.
Methods: The authors searched the literature for evidence of 1) if TCD provides useful information in specific clinical settings; 2) if using this information improves clinical decision making, as reflected by improved patient outcomes; and 3) if TCD is preferable to other diagnostic tests in these clinical situations.
Results: TCD is of established value in the screening of children aged 2 to 16 years with sickle cell disease for stroke risk (Type A, Class I) and the detection and monitoring of angiographic vasospasm after spontaneous subarachnoid hemorrhage (Type A, Class I to II). TCD and TCCS provide important information and may have value for detection of intracranial steno-occlusive disease (Type B, Class II to III), vasomotor reactivity testing (Type B, Class II to III), detection of cerebral circulatory arrest/brain death (Type A, Class II), monitoring carotid endarterectomy (Type B, Class II to III), monitoring cerebral thrombolysis (Type B, Class II to III), and monitoring coronary artery bypass graft operations (Type B to C, Class II to III). Contrast-enhanced TCD/TCCS can also provide useful information in right-to-left cardiac/extracardiac shunts (Type A, Class II), intracranial occlusive disease (Type B, Class II to IV), and hemorrhagic cerebrovascular disease (Type B, Class II to IV), although other techniques may be preferable in these settings.
Received August 28, 2003. Accepted in final form March 1, 2004.
*See Appendix 1 on page 1479 for a complete list of Subcommittee members.
Approved by the Therapeutics and Technology Assessment Subcommittee on August 8, 2003. Approved by the Practice Committee on November 8, 2003. Approved by the Board of Directors on January 18, 2004.
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