Том 9, брой 2 - 2013/ Vol. 9, No. 2 - 2013

T. Shiogai
Department of Clinical Neuroscience, Kyoto Takeda Hospital – Kyoto, Japan


Professor Hiroshi Furuhata passed away aged 67 years old on August 11th 2012. He gave tremendous contribution to our Neurosonology Research Group of the World Federation of Neurology (NSRG-WFN). He served as the secretary-general of the 4th meeting held in Hiroshima in 1991 and edited the proceedings (Recent Advances in Neurosonology). Subsequently, he served as the chairman of our NSRG-WFN from 1991-1994, as the Honorary President of the 7th meeting (Winston-Salem) and 8th NSRG Meeting (Taipei), and was an executive committee and Advisory Board member from 2001.

M. Mijajlovic
Neurology Clinic, Clinical Center of Serbia and School of Medicine University of Belgrade – Belgrade, Serbia

Transcranial Doppler (TCD) is a relatively new, non-invasive tool, allowing for bedside monitoring to determine flow velocities indicative of changes in vascular caliber.
It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma.
TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous monitoring of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP.
Growing body of literature demonstrates the usefulness of transbulbar B-mode sonography of the optic nerve for detecting increased ICP in patients requiring neurocritical care.

T. Rundek
Miller School of Medicine University of Miami – Miami, USA

Carotid atherosclerotic disease plays a large role in the etiology of stroke. B-mode carotid ultrasound has been widely used to detect subclinical carotid atherosclerosis by quantifying carotid intima–media thickness (cIMT) and carotid plaque (CP). Both cIMT and CP have been accepted surrogate imaging biomarkers of subclinical atherosclerosis until recently when it became increasingly clear that cIMT and CP may be genetically and biologically distinct atherosclerotic phenotypes with evidence of heterogeneous etiology. In addition, carotid atherosclerotic plaque burden, defined as the

E. Bartels
Center for Neurological Vascular Diagnostics – Munich, Germany


In this lecture the typical ultrasonographic findings in cerebral occlusive disease will be presented.
Data concerning the sensitivity and specificity of TCCS in intracranial stenosis remain limited. Furthermore, limited criteria for the quantification of intracranial stenosis by TCCS are available. The classification is based on conventional TCD studies.
The degree of stenosis is estimated on the basis of the changes of the Doppler spectrum (increased flow velocities in the site of the stenosis, and flow disturbancies upstream and downstream from the lesion). TCCS provides information on the localization of the stenosis. Using the frequency dependent color-coding, the site of the stenosis can be more easily recognized due to the aliasing phenomenon.

F. Perren
HUG, University Hospital and Medical Faculty of Geneva, Department of Clinical Neurosciences, Neurosonology Unit – Geneva, Switzerland


Following aspects will be presented: brief introduction on: risk factors / strokes due to internal carotid and vertebral artery stenosis, epidemiological data, grading of the ICA/VA stenoses: methods and grading steps, assessment, hemodynamic effects, pitfalls, recommendations, review of the literature.

K. Niederkorn
Deprtment of Neurology, Section of Neurosonology, Medical University Graz – Graz, Austria


The following topics will be discussed:
• Diagnosis of stenosis and occlusion in the carotid system.
• Degree of Stenosis-NASCET and ECST grading systems and clinical implications.
• Carotid vessel wall pathology- plaque characterization.
• Vertebral artery pathology- steosisi, occlusion, collaterals.
• Follow-up ofter carotid and vertebral artery stenting.

W. Mess
University Hospital – Maastricht, Netherlands


This tutorial will cover the basic knowledge of the arterial blood supply of the brain. The extracranial anterior and posterior system, i.e. the carotid and the vertebral arteries will be discussed as well as the intracranial arteries. Special attention will be paid to the concept of endarteries versus collateral blood supply. The latter comprises of course the circle of Willis. Also, there will be a short reflection on the anatomical properties of the vessel wall, which are the prerequisite for their functional behaviour.

A. Hetzel
Neurological Clinic Park-Klinikum – Bad Krozingen, Germany


Main topics with additional learning objects of this part of the NSRG teaching course will be:
1. Relationships of flow rate, pressure and flow resistance: flow rate is determined by pressure difference at the end of the vessel and flow resistance. The relationship is expressed analogous to Ohm’s law.
2. Laminar and turbulent flow: mean flow velocity corresponds closely to flow rate under laminar flow conditions, narrowing of the lumen leads to a acceleration of blood flow. The proportional increase of the Reynolds number result to a critical value. Over this turbulent flow occur with irregular, disorganized blood flow in all directions.

G.-M. von Reutern
Neurologische Praxis am Kardiologischen Zentrum – Bad Nauheim, Germany


The following topics will be discussed:
• Parameters of spectral analysis of Doppler recordings.
• Spectral analysis in case of undisturbed flow.
• Spectral analysis in case of disturbed flow.
• Technical influences on the Doppler spectrum.
• Measurement of velocity.
• Angle correction.

M. Siebler
Mediclin / Essen Kettwig, Department of Neurorehabilitation / University of Duesseldorf – Essen, Germany


In this tutorial, we demonstrate physical principles, which are relevant in the practical routine in ultrasound diagnostics. Beside the interaction of ultrasound with the tissue, basics of the effects of frequency, propagation velocity, pulse repetition frequency, scattering and beam formation are illustrated. Practical examples and typical artifacts are discussed as well as influence on the machine settings (Beam focus, TI, MI, focus) on the quality of your analysis. The effects of data post processing (e.g. tissue harmonic imaging, rendering etc) will be demonstrated. Finally, the correct disinfection in clinical routine is presented.

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