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June 24, 2009

Submandibular TCD approach detects post-bulb ICA stenosis in children with sickle cell anemia

August 4, 2009 issue
73 (5) 362-365

Abstract

Background: Transcranial Doppler (TCD) ultrasound is a procedure commonly used to screen individuals with the major hemoglobin S diseases, Hb SS and Hb S-beta0, for significant stenoses in the circle of Willis. Flow velocities above 200 cm/s have been shown to identify patients at elevated risk for cerebral infarction. Among TCD’s limitations is the inability to insonate the distal extracranial, petrous, and cavernous internal carotid artery (ICA) through the standard transtemporal approach.
Methods: We extended the submandibular approach to include infra-siphon portions of the ICA.
Results: Using the extended submandibular approach to evaluate these portions of the ICA, we identified stenotic lesions in 4 patients with Hb SS disease out of a population of 131 children with Hb SS. Three of the 4 patients had no history of overt stroke or stroke-like symptoms. Neuroimaging confirmed the stenotic lesions, and also revealed watershed infarction as well as discrete areas of silent infarction. All 4 children had neuropsychological impairment.
Conclusions: The submandibular approach, when added to a standard transcranial Doppler examination, may increase the sensitivity of this technique to identify important potential sources of cerebral infarction.

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Information

Published In

Neurology®
Volume 73Number 5August 4, 2009
Pages: 362-365
PubMed: 19553593

Publication History

Published online: June 24, 2009
Published in print: August 4, 2009

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Authors

Affiliations & Disclosures

Mark J. Gorman, MD
From the Stroke Program (M.J.G.), Department of Neurology, University of Vermont, Burlington; Stroke Program (K.N.), Yale-New Haven Hospital; and Department of Pediatrics (J.C., H.P.), Yale University School of Medicine, New Haven, CT.
Karin Nyström, APRN
From the Stroke Program (M.J.G.), Department of Neurology, University of Vermont, Burlington; Stroke Program (K.N.), Yale-New Haven Hospital; and Department of Pediatrics (J.C., H.P.), Yale University School of Medicine, New Haven, CT.
Judith Carbonella, APRN
From the Stroke Program (M.J.G.), Department of Neurology, University of Vermont, Burlington; Stroke Program (K.N.), Yale-New Haven Hospital; and Department of Pediatrics (J.C., H.P.), Yale University School of Medicine, New Haven, CT.
Howard Pearson, MD
From the Stroke Program (M.J.G.), Department of Neurology, University of Vermont, Burlington; Stroke Program (K.N.), Yale-New Haven Hospital; and Department of Pediatrics (J.C., H.P.), Yale University School of Medicine, New Haven, CT.

Notes

Address correspondence and reprint requests to Dr. Mark J. Gorman, Department of Neurology, Given C219D, 89 Beaumont Avenue, Burlington, VT 05405-0068 [email protected]

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  9. Extracranial internal carotid artery stenosis in children with sickle cell disease – Which transducer, what measurement?, Ultrasound, 24, 2, (86-93), (2016).https://doi.org/10.1177/1742271X16638891
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  10. Chronic and acute anemia and extracranial internal carotid stenosis are risk factors for silent cerebral infarcts in sickle cell anemia, Blood, 125, 10, (1653-1661), (2015).https://doi.org/10.1182/blood-2014-09-599852
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